Anxiety and Stress Among Under

Neuropsychiatric Disease and Treatment Dovepress
open access to scientific and medical research
Open Access Full Text Article

ORIGINAL RESEARCH
Anxiety and Stress Among Undergraduate Medical

Students of Haramaya University, Eastern Ethiopia
Neuropsychiatric Disease and Treatment downloaded from https://www.dovepress.com/ by 165.215.209.15 on 18-Feb-2021
This article was published in the following Dove Press journal:

Neuropsychiatric Disease and Treatment
Henock Asfaw 1 Background: The perceived stress and anxiety among medical students have bleak con
Gelana Fekadu 2 sequences on their academic performances, physical, and psychological wellbeing. However,
Mandaras Tariku 1 there is a dearth of reliable epidemiological studies in Ethiopia on medical student’s
Amanuel Oljira 2 experience of stress and anxiety. Therefore, this study was aimed to determine the prevalence
and identify factors associated with stress and anxiety among undergraduate medical students
1
Department of Psychiatry, School of
of Haramaya University, Eastern Ethiopia.
Nursing and Midwifery, College of Health
For personal use only.
and Medical Science, Haramaya Methods: An institutional-based cross-sectional study was conducted from May 13 to June 12,
University, Harar, Ethiopia; 2Department 2019 among 523 participants selected by simple random sampling technique. Data were
of Nursing, School of Nursing and
Midwifery, College of Health and Medical collected by using structured questionarie through self-adminstered method. Data were entered
Science, Haramaya University, Harar, by Epidata version 3.1 and analyzed using Stastical Package for Social Science(SPSS) version
Ethiopia 22. Bivariableand multivariable logistic regression analysis were conducted to identify factors
associated with anxiety and stress. Adjusted Odd Ratio (AOR) and 95% Confidence Interval(CI)
was used to show the strength of association, and P-value of 0.05 was used to declare statistical
significance.
Results: The prevalence of stress was 44% (95% CI: 40.2%–48.2%) and anxiety was 48.9% (95%
CI: 44.6%−53.3%) among undergraduate medical students of Haramaya University. Being female
(AOR=1.90, 95% CI: 1.28–2.81) and living off-campus (AOR=1.75, 95% CI: 1.12–2.73) were
factors significantly associated with both stress and anxiety. Whereas, alcohol use (AOR=2.26,
95% CI: 1.50–3.50) and smoking cigarette (AOR=3.50, 95% CI: 1.58–7.73) linked with stress. The
poor psychosocial support (AOR=1.93, 95% CI: 1.20–3.20) was significantly associated with
anxiety.
Conclusion: Substantially a higher level of stress and anxiety was reported. Being female
and living off-campus were linked with both stress and anxiety. Where as, alcohol use and
smoking cigarette were associated with stress and poor psychological support was signifi
cantly associated with anxiety.
Keywords: stress, anxiety, medical students, Haramaya University, Ethiopia
Introduction
Stress and anxiety often appear after one another.1 But stress is typically caused
by an external trigger and it can be a short term.2 Anxiety, on the other hand, is
defined by persistent excessive worries that do not go away even in the absence
of stressors. However, their symptoms are nearly identical.2 In common, anxiety
Correspondence: Gelana Fekadu
Department of Nursing, School of and stress results from an interaction between persons and their environment
Nursing and Midwifery, College of Health
and Medical Science, Haramaya
that are perceived as straining or exceeding their adaptive capacities.3 Constant
University, Harar, Ethiopia exposure to anxious and stressful situations may increase susceptibility to
Tel +251933316505
Email fekadugelana4@gmail.com a variety of health problems.4 Effects may range from mild, moderate to severe
submit your manuscript | www.dovepress.com Neuropsychiatric Disease and Treatment 2021:17 139–146 139
DovePress © 2021 Asfaw et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.
http://doi.org/10.2147/NDT.S290879
php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the
work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For
permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
Powered by TCPDF (www.tcpdf.org)

Asfaw et al Dovepress
health problems and it depends onstressor’s duration and Method

individual’s ability to cope.5
Study Period and Area
The medical school environment has been recognized
The study was conducted at Haramaya University, College
as anxious and stressful for the students due to the curri
of Health and Medical Science, from May 13 to June 12,
cular and extra-curricular situations.6 The perceived stress
2019. Haramaya University is located in the eastern part of
and anxiety among medical students have negative con
the country at a distance of 510 km from the capital city,
sequences on their academic performances, physical and

Addis Ababa. The university has two campuses and nine
psychological well-being.6
colleges. The Harar campus (College of Health and
The prevalence of anxiety and stress among medical
Medical Science) is found at a distance of 17kilometers
students has been reported higher compared to the gen
away from the main campus. School of medicine emerged
eral population and age-matched peers. Accordingly, the
as an academic constituent in 2007 and currently, a total of
study results from different countries pointed out the
1315, students are following their education in 2019
prevalence of anxiety and stress among medical students
(unpublished data. School of medicine, College of Health
is 37.2% and 47.1% in Brazil,7 50.6% and 32.8% in
and Medical Science, Haramaya University).
India,8 62.5% and 45.1% in Iraq,9 63% and 41% in
Saudi Arabia,10 and 64.3% and 62.4% in Egypt11
respectively.
Study Design and Population
Institutional based cross-sectional study design was used.
In Ethiopia, the reported prevalence of anxiety
All selected undergraduate medical students were included

ranges from 30.1% among Addis Ababa University12
for study and students transferred from other universities
to 60.8% among Arsi University medical students,13
and stayed for less than six months at the university were
whereas, the stress ranges from 40.4% among Arsi
excluded.
university13 to 52.4% among Jimma university medical
students.14
Studies showed the level of stress and anxiety experi Sample Size and Sampling Technique
enced by students is elucidated by many factors. Living Single population proportion formula was used to calcu
off-campus,15 higher body mass index,11 smoking, being late sample size by considering the assumptions: ni: mini
female, being first and second-year Students linked with mum sample size required for the study, Z= standard
a higher level of both anxiety and stress.10,12,16 Likewise, normal distribution (Z=1.96) with a confidence interval
stress among medical students associated with perceived of 95% and α=0.05, P=the prevalence anxiety among
sleeping problem,17 living situation, monthly income, and medical students of Addis Ababa University, 30.1%,12
educational level.14 Students with poor social support, first d=tolerable margin of error (d) =4%. The total sample
and second-year educational levels were more anxious as size for this study was 556 with a 10% non-response rate
compared to their counterparts.12 added. The simple random sampling technique was used to
Failure to detect the psychological abnormality among select study participants after proportional allocation of the
medical students may lead to increased mental illness with sample size according to the student's academic year.
unwanted outcomes throughout their careers and lives.18
Early detection and treatment of such problems will shorten Data Collection Tool and Procedure
the duration of illness and lessens the long-term social The data was collected by using a standardized tool. The
impairment.19 socio-demographic characteristics; age, sex, marital status,
Despite few studies12,14,20,21 assessed the preva and living conditions were collected. ASSIST (Alcohol,
lence and identified risk factors of stress and anxiety Smoking and Substance Involvement Screening Test),
among medical students, there is a lack of epidemiolo which was developed by the World Health Organization,
gically reliable and study with enough sample size in was used to assess the psychoactive substance use
Ethiopia. Therefore, this study was aimed to determine (WHO).22
the prevalence and identify factors associated with Depression, anxiety, and stress: Were measured by
stress and anxiety among undergraduate medical stu Depression, Anxiety, and Stress Scale (DASS-21) short
dents of Haramaya University, Eastern Ethiopia. form, which has 21 items and seven items each. It was
140 submit your manuscript | www.dovepress.com Neuropsychiatric Disease and Treatment 2021:17
DovePress

Dovepress Asfaw et al
the Likert scale ranges from zero to three,computed and Table 1 Socio-Demographic Characteristics of Undergraduate
multiplied by two. The sum scores of ten and above was Medical Students of Haramaya University, Eastern Ethiopia, 2019
(N=523)
indicative of depression, eight and above was indicative of
anxiety since,15 and above was for the stress.23 Variables Category Frequency Percentage
Suicidal history: It was assessed by the module of the Mean Standard
world mental health survey initiative version of the WHO Deviation
and CIDI (Composite International Diagnostic

CGPA 3.00 0.63
Interview).24 Concerning the social support, the Oslo-
Age in years 23.6 2.36
three-item, social support scale was used.25 Four psychia
tric nurses (bachelor of degree holder) were participated in Sex Male 362 69.2
data collection through self-administered technique and Female 161 30.2
supervised by one psychiatrist (master’s degree holder). Marital status Single/divorced 466 89.1
Married 57 10.9
Data Quality Control Living situation In campus 393 75.1

Pre-test was done among Dire Dawa University medical Off campus 130 24.9
students on 5% (28) of total samples, and relevant mod Religion Orthodox 266 50.9
ification taken. During the data collection, the question Muslim 135 25.8
naire was checked for its completeness on daily basis by Protestant 104 19.9
supervisors and investigators. Double data entry was con Others* 18 3.4
ducted by two independent data clerks, and the proper Educational level First year 58 11.1
corrections were made based on the variation between Second year 78 15.0
two data clerks. Third year 89 17.0
Fourth year 84 16.1
Fifth year 99 19.0
Data Processing and Analysis Sixth year 115 22.0
The data was checked and entered to Epi-Data version 3.1 Note: *Wakefata, Atheist, Catholic, Jehovah witness and Apostle.
and exported to SPSS (Statistical Package for Social Science)
version 22 for analysis. Descriptive statistics (percentage,
ranging from, 1.83 to 3.87 and, 115 (22%) students were
mean and standard deviations), bivariable and multivariable
6th year, followed by 5th year, 99 (19%) in the medical school
binary logistic regression analysis was performed to identify
(Table 1).
factors associated with stress and anxiety. All variables with
a P-value less than 0.25 at bivariable logistic regression
analyses were entered into the multivariable logistic regres
Substance Use History
About,146 (27.9%) students have been consuming alcohol
sion model, and variables with a P-value less than 0.05 at
and, 41 (7.8%) students were smoking cigarette in the past,
95% confidence interval with their adjusted odds ratio were
3 months (Figure 1).
considered statistically significant.
Clinical and Psychosocial Characteristics

Results A total of, 228 (43.6%) students had depressive symptoms,
Socio-Demographic Characteristics of 120 (22.9%) had suicidal ideation, and, 22 (4.2%) had
Participants a suicidal attempt. Around, 223 (42.6%) students reported
A total of 523 undergraduate medical students were included in moderate perceived social support (Table 2).
the study with a response rate of 94%. The mean age of the
students were, 23.62 years (±2.36SD) with ages ranging from, Prevalence of Stress and Anxiety
19 to 34 years. The majority of the students, 362 (69.2%) were The prevalence of stress was, 230(44%) (95% CI: 40.2%–
male, 266 (50.9%) orthodox by religion and, 393 (75.1%) were 48.4%) and anxiety was, 256(48.9%) (95% CI: 44.6%
living in the campus. Regarding their cumulative grade point −53.3%) among undergraduate medical students
average, the mean grade of students was, 3.00 with grades (Figure 2).
submit your manuscript | www.dovepress.com

Neuropsychiatric Disease and Treatment 2021:17 141
DovePress

30.00% 27.9%
60
25.00%
50
20.1% 56%
20.00% 51.1%
Percentage
40
48.9%
44%
15.00%
30
Exposed Non-exposed
10.00% 7.8% 20
5.00% 4.2% 10
0.00% 0
Alcohol Cigarette Khat Others Stress Anxiety
Current substance use
Figure 2 Prevalence of stress and anxiety of undergraduate medical students of
Haramaya University, Eastern Ethiopia, 2019 (N=523).
Figure 1 Substance use characteristics of undergraduate medical students of
Haramaya University, Eastern Ethiopia, 2019 (N=523).
(P-value less than 0.25) and were taken into a multivariable

Among students with stress, 61% were males and, logistic regression model to control confounding factors.
60.5% were among those with anxiety (Table 3). From the multivariable logistic regression analysis
being female, living off-campus, current alcohol use, cur
rent cigarette use, and poor social support were found to

Factors Associated with Stress and be statistically significant at P-value less than 0.05.
Anxiety According to the current study female students experience
During the bivariable analysis; sex, marital status, living stress; 1.9 times (AOR=1.90, 95% CI: 1.28–2.81) and anxi
situation, family history of suicidal attempt, family history ety; 2.1 times (AOR=2.10, 95% CI: 1.40–3.10) more likely
of mental illness, current alcohol use, current cigarette use, than male students. The odds of having stress and anxiety
and current khat use fulfilled the minimum requirement among students who were living off-campus were 1.75 times
(AOR=1.75, 95% CI: 1.12–2.73) and 2.21 times (AOR=2.21,
95% CI: 1.42–3.44) higher as compared to the students who
were living in the campus respectively. Those students using
Table 2 Clinical and Psychosocial Characteristics of
Undergraduate Medical Students of Haramaya University, alcohol were 2.28 times (AOR=2.26, 95% CI: 1.50–3.50)
Eastern Ethiopia, 2019 (N=523) more likely to experience stress as compared to non-
Variables Category Frequency Percentage

Table 3 Prevalence of Stress and Anxiety Among Undergraduate
Depressive Yes 228 43.6
No 295 56.4
Medical Students of Haramaya University, Eastern Ethiopia
Characteristics Stress Anxiety
Suicidal ideation Yes 120 22.9
No 403 77.1 Sex Male 61% 60.5%
Female 39% 39.5%
Suicidal attempt Yes 22 4.2
No 501 95.8 Living situation In campus 69.5% 66.7%
Off campus 30.5% 33.3%
Family history of Yes 41 7.8
suicidal attempt No 482 92.2 Marital status Married 9% 12.5%
Single 91% 87.5%
Family history of Yes 22 4.2
committed suicide No 501 95.8 Current alcohol use Yes 37.8% 33%
No 62.2% 67%
Family history of mental Yes 57 10.9
illness No 466 89.1 Current khat use Yes 23% 72.6%
No 77% 27.4%
Perceived social Poor 192 36.7%
support Moderate 223 42.6% Current cigarette use Yes 13% 9.3%
Strong 108 20.7% No 87% 90.7%
DovePress

alcoholic students. Similarly, students who smoke cigarettes Egypt, stress, 62.4% and Anxiety, 64.3%,11 in Saud Arabia,
were 3.5 times (AOR=3.50, 95% CI: 1.58–7.73) more likely stress, 71.9%.17 This variation could be attributed to socio-
to have anxiety as compared to nonsmokers. Whereas, stu cultural differences, and the tools used for the study.11
dents with poor social support were 1.93 times (AOR=1.93, The study finding from Jordan29 and Michigan University
95% CI: 1.20–3.20) more likely to have anxiety as compared reported a lower level of anxiety, 13.58% and 15.6% among
with students with strong social support (Table 4). university students respectively30 as compared to our study
finding. This could be linked with the fact that students in

Discussion a developed country may have less financial hardship com
This study determined the prevalence and identified the factors pared to those students in low-income countries including
associated with stress and anxiety among undergraduate med Ethiopia.31
ical students of Haramaya University. Hence, the overall pre This study identified gender difference in the self-reported
valence of stress and anxiety was, 44% (95% CI: 40.2%- level of stress and anxiety with much higher among female
48.4%) and 48.9% (95% CI: 44.6%-53.3%) respectively. students. This finding is in consonance with study results
This is in line with the study finding from Turkey, 47.1% for conducted among Egyptian and Turkish female students
anxiety,16 Hong Kong University, 54.4% for anxiety26 and reporting a higher level of stress and anxiety.11,28 This is
Malaysia, 41.9% for stress.27 However, the current finding is possibly due to the fact that females complain more about
lower as compared to the study finding by Abdallah et al the high load of the curriculum and they are also more likely to
report the stress, physical and psychological symptoms.32
(2014) with the prevalence of stress, 57.8%, and anxiety,

78.4%.28 Similar studies from other countries showed far Additionally, the study result conducted among a sample of
higher rates of stress and anxiety among medical students; in college students in the United States of America outlined the
Table 4 Factors Associated with Stress and Anxiety Among Undergraduate Medical Students of Haramaya University, Eastern
Ethiopia, 2019
Characteristics Stress COR AOR Anxiety COR(95% CI) AOR(95% CI)
(95% CI) (95% CI)
Yes No Yes No
Sex Male 140 222 1 1 155 207 1 1

Female 90 71 2.01(1.38–2.93) 1.90(1.28–2.81)* 101 60 2.25(1.54–3.30) 2.1(1.40–3.10)**
Living situation In campus 160 233 1 1 171 222 1 1

Off campus 70 60 1.70(1.14–2.53) 1.75(1.12–2.73)* 85 45 2.45(1.62–3.71) 2.21(1.42–3.44)*
Marital status Married 21 36 1 1 32 25 1 1

Single 209 257 1.40(0.80–2.50) 1.770.94–3.33) 224 242 0.72(0.42–1.30) 1.02(0.60–1.90)
Family history of suicidal attempt Yes 22 19 1.53(0.80–2.90) 1.10,(0.52–2.30) 26 15 1.90(0.98–3.70) 1.28(0.60–2.80)

No 208 274 1 1 230 252 1 1
Family history of mental illness Yes 31 26 1.60(0.92–2.80) 1.75(0.92–3.32) 36 21 1.92(1.10–3.38) 1.90(0.90–3.64)

No 199 267 1 1 220 246 1 1
Current alcohol use Yes 87 59 2.40(1.63–3.60) 2.28(1.50–3.50)** 82 64 1.50(1.02–2.20) 1.50(0.94–2.21)

No 143 234 1 1 174 203 1 1
Current khat use Yes 53 52 1.40,(0.90–2.13) 0.75(0.45–1.25)

No 177 241 1 1
Current cigarette use Yes 30 11 3.85(1.90–7.86) 3.50(1.58–7.73)* 24 17 1.52(0.80–2.90) 1.10(0.53–2.20)

No 200 282 1 1 232 250 1 1
Perceived social support Strong 43 65 1 1

Moderate 102 121 1.27(0.80–2.03) 1.30(0.80–2.10)
Poor 111 81 2.07(1.28–3.35) 1.93(1.20–3.20)**
Notes: *p<0.05 and **p<0.001.

Abbreviations: COR, crude odds ratio; AOR, adjusted odds ratio.

DovePress

body image and lower self-esteem was the significant contri relationship. The study was also conducted in one university
butor of stress and anxiety among females.15 and might not be generalized to whole university students.
Our current study suggests the living situation of stu Despite these limitations, the study expanded our knowledge
dents contributes to stress and anxiety. Students living off- on the prevalence and factors associated with stress and anxiety
campus were reported more stress and anxiety than those among undergraduate medical students of Haramaya
who are living in a campus dormitory. This is in agreement University. It also provides an insight for the Haramaya
with previous study findings.30,33–36 This could be linked University administrators and stakeholders to tackle the pro
with the fact that students live off-campus were responsi blem. Additionally, the current finding might help as baseline
ble to pay monthly house rent, prepare or buy daily meals data for further studies with advanced methods and multi
and deal any issues raised related to the house or apart centers.
ment they live in.15 There is also evidences that living
alone is the risk factor for stress and anxiety.37,38 So the Conclusion
university has to give psychosocial support for students The study depicted the higher prevalence of stress and anxiety
living off-campus. The students also need to get ready among undergraduate medical students of Haramaya
before they plan to live off-campus.30 University. Being female gender, living off-campus, perceived
Good social support is perceived to have a positive effect poor social support, using alcohol and cigarette were asso
on health and defined as through which social relationships ciated with stress and anxiety. The establishment of students’
promote health and well-being.39 Our study finding also deli counseling, behavioral change, and communication unit in
neated students who have poor social support were more medical schools, promoting student wellbeing, providing sup
anxious than students who have good social support. This is portive, preventive, and curative psychosocial services to
in agreement with the previous study results.40,41 Hamadan enable students to cope with their new phase of life is recom
et al (2008) also depicted that University students who have mended. Medical schools have to encourage students to spend
a lower perception of social support are expected to have more time on their social lives and provide them with coping
a higher perception of life events as anxious situations.42 tools to overcome stress throughout their medical education.
Both social cognitive and stress environment model There should be special attention given to female students and
emphasizes the reciprocated association among physiological, those living off-campus. Leisure activities should be included
cognitive, behavioral, and socio-environmental factors that in the curriculum to promote better interaction between the
can both cause stress symptoms as well as mediate effective students and their medical environment.
coping responses to stressors.43 Evidences also showed up the
relationship between stress and alcohol looks like a vicious Abbreviations
circle.44,45 Stress is a significant motivator for university stu AOR, adjusted odds ratio; ASSIST, Alcohol; Smoking and
dents to drink alcohol or smoke cigarettes as a coping mechan Substance Involvement Screening Test; CPGA, Cumulative
ism. Despite, it is not merely the reason, occasional Grade Point Average; CI, Confidence Interval; CIDI,
celebration, peer pressure, and social acceptance were Composite International Diagnostic Interview; COR, Crude
raised.46 Reciprocally the intended coping mechanism may Odds Ratio; DASS, Depression; Anxiety; Stress Scale; SD,
lead to stress. standard deviation.
Our study finding also highlighted students who drink
alcohol and smoke cigarette were more likely to experience Data Sharing Statement
stress than their counterparts. This is supported by previously The datasets used for analysis are available from the
conducted study results which revealed the excessive alcohol corresponding author upon a reasonable request.
consumption and smoking cigarette, which is considered as
a coping response, in turn, have exacerbated the stress Ethical Approval
symptoms.47 The ill-effects of the substance abuse among This study was conducted in accordance with the Declaration
medical students, were not limited to the psychological stress of Helsinki-Ethical principle for medical research involving
but lead to physical impairment, poor interpersonal relation the human subjects. Accordingly, the ethical clearance was
ships and poor academic performance.46 obtained from a joint ethical review committee of the
This study was not without limitation. Its cross-sectional University of Gondar and Amanuel mental specialized hospi
nature may fail to capture the long-term cause and effect tal. A formal letter was obtained from the University of Gondar
DovePress

and submitted to Haramaya University, College of Health and 7. Moutinho ILD, Maddalena N, Roland RK, et al. Depression, stress and
anxiety in medical students: a cross-sectional comparison between stu
Medical Science for administrative approval. Written informed dents from different semesters. Revista Da Associação Médica
consent was obtained from the students prior to the data Brasileira. 2017;63(1):21–28. doi:10.1590/1806-9282.63.01.21
collection by explaining the purpose of the study. Those who 8. Kumar SD, Kavitha H, Kulkarni P, Siddalingappa H, Manjunath R.
Depression, anxiety and stress levels among medical students in
did not wish to take part could be allowed either to withdraw Mysore, Karnataka, India. Int J Community Med Public Heal.
from the study at any time they want. All informations col 2016;359–362. doi:10.18203/2394-6040.ijcmph20151591
9. Rasheed AG, Hussein AG. Depression, anxiety, and stress among

lected from the subjects were handled confidentially.
medical students of College of Medicine, Hawler Medical University,
Erbil, Iraq. Zanco J Med Sci. 2019;23(2):143–152. doi:10.15218/
zjms.2019.019
Acknowledgments 10. Kulsoom B, Afsar NA. Stress, anxiety, and depression among med
We are grateful to data collectors for their admirable ical students in a multiethnic setting. Neuropsychiatr Dis Treat.
endeavor during the data collection. Also, our appreciation 2015;11:1713. doi:10.2147/NDT.S83577
11. Wahed WYA, Hassan SK. Prevalence and associated factors of stress,
goes to study participants for their participation. anxiety and depression among medical Fayoum University students.
Alexandria J Med. 2017;53(1):77–84. doi:10.1016/j.ajme.2016.01.005
12. Kebede MA, Anbessie B, Ayano G. Prevalence and predictors of
Author Contributions depression and anxiety among medical students in Addis Ababa,
All authors made a significant contribution to the work Ethiopia. Int J Ment Health Syst. 2019;13(1):30. doi:10.1186/
s13033-019-0287-6
reported, whether that is in the conception, study design,
13. Melaku L, Bulcha G. The depression, anxiety, and stress and their
execution, acquisition of data, analysis and interpretation, sociodemographic correlates among undergraduate medical students
of Arsi University, Southeast Ethiopia. Int J Health Allied Sci. 2020;9
or in all these areas; took part in drafting, revising or

(2):105. doi:10.4103/ijhas.IJHAS_81_19
critically reviewing the article; gave final approval of the 14. Melaku L, Mossie A, Negash A. Stress among medical students and
version to be published; have agreed on the journal to its association with substance use and academic performance.
which the article has been submitted; and agree to be J Biomed Educ. 2015;2015:1–9. doi:10.1155/2015/149509
15. Beiter R, Nash R, McCrady M, et al. The prevalence and correlates of
accountable for all aspects of the work. depression, anxiety, and stress in a sample of college students.
J Affect Disord. 2015;173:90–96. doi:10.1016/j.jad.2014.10.054
16. Bayram N, Bilgel N. The prevalence and socio-demographic correla
Funding tions of depression, anxiety and stress among a group of university
The study was funded by the University of Gonder. But, students. Soc Psychiatry Psychiatr Epidemiol. 2008;43(8):667–672.
doi:10.1007/s00127-008-0345-x
the funding institution has no role on the consent for 17. Sani M, Mahfouz M, Bani I, et al. Prevalence of stress among
publication. medical students in Jizan University, Kingdom of Saudi Arabia.
Gulf Med J. 2012;1(1):19–25.
18. Tyssen R, Vaglum P, Grønvold NT, Ekeberg Ø. Suicidal ideation
Disclosure among medical students and young physicians: a nationwide and
The authors declare that they have no conflicts of interest prospective study of prevalence and predictors. J Affect Disord.
2001;64(1):69–79. doi:10.1016/S0165-0327(00)00205-6
for this study. 19. Pignone MP, Gaynes BN, Rushton JL, et al. Screening for depression
in adults: a summary of the evidence for the US Preventive Services
Task Force. Ann Intern Med. 2002;136(10):765–776. doi:10.7326/
References 0003-4819-136-10-200205210-00013
1. Maurer J, Rebbapragada V, Borson S, et al. Anxiety and depression in 20. Melese B, Bayu B, Wondwossen F, et al. Prevalence of mental
COPD: current understanding, unanswered questions, and research distress and associated factors among Hawassa University medical
needs. Chest. 2008;134(4):43S–56S. doi:10.1378/chest.08-0342 students, Southern Ethiopia: a cross-sectional study. BMC Res Notes.
2. Association. AP. What’s the Difference Between Stress and Anxiety?; 2020. 2016;9(1):485. doi:10.1186/s13104-016-2289-7
3. Swaminathan A, Viswanathan S, Gnanadurai T, Ayyavoo S, 21. Tsegay L, Tesfaye G, Ayano G. The prevalence and associated factors
Manickam T. Perceived stress and sources of stress among first-year of suicidal attempt among medical students in Addis Ababa Ethiopia.
medical undergraduate students in a private medical college–Tamil Psychiatric Quarterly. 2020;1–13.
Nadu. Natl J Physiol Pharm Pharmacol. 2016;6(1):9–14. 22. WHO. Group, WHO ASSIST Working The alcohol, smoking and
doi:10.5455/njppp.2015.5.1909201574 substance involvement screening test (ASSIST): development, relia
4. Tabalipa F, Souza M, Pfützenreuter G, Lima VC, Traebert E, bility and feasibility. Addiction. 2002;97(9):1183–1194. doi:10.1046/
Traebert J. Prevalence of anxiety and depression among medical j.1360-0443.2002.00185.x
students. Revista Brasileira De Educação Médica. 2015;39 23. Lovibond PF, Lovibond SH. The structure of negative emotional
(3):388–394. doi:10.1590/1981-52712015v39n3e02662014 states: comparison of the Depression Anxiety Stress Scales (DASS)
5. Shin LM, Liberzon I. The neurocircuitry of fear, stress, and anxiety with the Beck Depression and Anxiety Inventories. Behav Res Ther.
disorders. Neuropsychopharmacology. 2010;35(1):169–191. 1995;33(3):335–343. doi:10.1016/0005-7967(94)00075-U
6. Solanky P, Desai B, Kavishwar A, Kantharia S. Study of psychological 24. Gelaye B, Williams MA, Lemma S, et al. Diagnostic validity of the
stress among undergraduate medical students of government medical composite international diagnostic interview (CIDI) depression mod
college, Surat. Int J Med Sci Public Health. 2012;1(2):38–42. ule in an East African population. Int J Psychiatry Med. 2013;46
doi:10.5455/ijmsph.2012.1.38-42 (4):387–405. doi:10.2190/PM.46.4.e

DovePress

25. Dalgard OS, Dowrick C, Lehtinen V, et al. Negative life events, 37. Cornwell EY, Waite LJ. Social disconnectedness, perceived isolation,
social support and gender difference in depression. Soc Psychiatry and health among older adults. J Health Soc Behav. 2009;50
Psychiatr Epidemiol. 2006;41(6):444–451. doi:10.1007/s00127-006- (1):31–48. doi:10.1177/002214650905000103
0051-5 38. Soysa CK, Wilcomb CJ. Mindfulness, self-compassion, self-efficacy,
26. Lun KW, Chan C, Ip PK, et al. Depression and anxiety among and gender as predictors of depression, anxiety, stress, and
university students in Hong Kong. Hong Kong Med J. 2018;24 well-being. Mindfulness. 2015;6(2):217–226. doi:10.1007/s12671-
(5):466–472. doi:10.12809/hkmj176915 013-0247-1
27. Sherina M, Rampal L, Kaneson N. Psychological stress among under 39. Cohen S, Underwood L, Gottlieb B. Measuring and intervening in
graduate medical students. Med J Malaysia. 2004;59(2):207–211. social support. Social Relationships Health. 2000;3–25.
28. Abdallah AR, Gabr HM. Depression, anxiety and stress among 40. Chao RCL. Managing perceived stress among college students: the
first year medical students in an Egyptian public university. Int Res roles of social support and dysfunctional coping. J College
J Med Med Sci. 2014;2(1):11–19. Counseling. 2012;15(1):5–21. doi:10.1002/j.2161-1882.2012.00002.x
29. Al-Omari WM, Al-Omiri MK. Dental anxiety among university 41. Osborn TL, Venturo-Conerly KE, Wasil AR, Schleider JL, Weisz JR.
students and its correlation with their field of study. J Appl Oral Depression and anxiety symptoms, social support, and demographic
Sci. 2009;17(3):199–203. doi:10.1590/S1678-77572009000300013 factors among Kenyan high school students. J Child Fam Stud.
30. Eisenberg D, Gollust SE, Golberstein E, Hefner JL. Prevalence and 2020;29(5):1432–1443. doi:10.1007/s10826-019-01646-8
correlates of depression, anxiety, and suicidality among university 42. Hamdan-Mansour AM, Dawani HA. Social support and stress among
students. Am j Orthopsychiatry. 2007;77(4):534–542. doi:10.1037/ university students in Jordan. Int J Ment Health Addict. 2008;6
0002-9432.77.4.534 (3):442–450. doi:10.1007/s11469-007-9112-6
31. Yusoff MSB, Rahim AFA, Baba AA, Ismail SB, Pa MNM. 43. Gordon HW. Early environmental stress and biological vulnerability
Prevalence and associated factors of stress, anxiety and depression to drug abuse. Psychoneuroendocrinology. 2002;27(1–2):115–126.
among prospective medical students. Asian J Psychiatr. 2013;6 doi:10.1016/S0306-4530(01)00039-7
(2):128–133. doi:10.1016/j.ajp.2012.09.012 44. Bandura A. Health promotion by social cognitive means. Health
32. Bostanci M, Ozdel O, Oguzhanoglu NK, et al. Depressive sympto Educ Behav. 2004;31(2):143–164. doi:10.1177/1090198104263660
45. Cook RF, Back AS, Trudeau J, McPherson T. Integrating substance
matology among university students in Denizli, Turkey: prevalence

and sociodemographic correlates. Croat Med J. 2005;46(1):96–100. abuse prevention into health promotion programs in the workplace:
33. Gillman JL, Kim HS, Alder SC, Durrant LH. Assessing the risk factors for a social cognitive intervention targeting the mainstream user. 2003.
suicidal thoughts at a nontraditional commuter school. J Am College 46. Arora A, Kannan S, Gowri S, Choudhary S, Sudarasanan S, Khosla P.
Health. 2006;55(1):17–26. doi:10.3200/JACH.55.1.17-26 Substance abuse amongst the medical graduate students in
34. Lester D. Depression and suicidal ideation in college students: a developing country. Indian J Med Res. 2016;143(1):101.
a preliminary study of campus variables. Psychol Rep. 2013;112 doi:10.4103/0971-5916.178617
(1):106–108. doi:10.2466/12.02.10.PR0.112.1.106-108 47. O’hare T, Sherrer MV. Co-occurring stress and substance abuse in
35. Omokhodion F, Gureje O. Psychosocial problems of clinical students college first offenders. J Hum Behav Soc Environ. 2000;3(1):29–44.
in the University of Ibadan Medical School. Afr J Med Med Sci. doi:10.1300/J137v03n01_02
2003;32(1):55.
36. Othieno CJ, Okoth RO, Peltzer K, Pengpid S, Malla LO. Depression
among university students in Kenya: prevalence and sociodemo
graphic correlates. J Affect Disord. 2014;165:120–125. doi:10.1016/
j.jad.2014.04.070
Neuropsychiatric Disease and Treatment Dovepress

Publish your work in this journal
Neuropsychiatric Disease and Treatment is an international, peer- is the official journal of The International Neuropsychiatric
reviewed journal of clinical therapeutics and pharmacology focusing Association (INA). The manuscript management system is comple
on concise rapid reporting of clinical or pre-clinical studies on a tely online and includes a very quick and fair peer-review system,
range of neuropsychiatric and neurological disorders. This journal is which is all easy to use. Visit http://www.dovepress.com/testimo
indexed on PubMed Central, the ‘PsycINFO’ database and CAS, and nials.php to read real quotes from published authors.
Submit your manuscript here: https://www.dovepress.com/neuropsychiatric-disease-and-treatment-journal
DovePress

© 2021. This work is licensed under
https://creativecommons.org/licenses/by-nc/3.0/ (the “License”).
Notwithstanding the ProQuest Terms and Conditions, you may use this content
in accordance with the terms of the License.

Anxiety and Stress Among Under

Uploaded by

Copyright:

Available Formats

Anxiety and Stress Among Under

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Anxiety and Stress Among Under

Uploaded by

Copyright:

Available Formats

Neuropsychiatric Disease and Treatment Dovepress

open access to scientific and medical research

Open Access Full Text Article

Anxiety and Stress Among Undergraduate Medical

This article was published in the following Dove Press journal:

Powered by TCPDF (www.tcpdf.org)

health problems and it depends onstressor’s duration and Method

sequences on their academic performances, physical and

All selected undergraduate medical students were included

Powered by TCPDF (www.tcpdf.org)

and CIDI (Composite International Diagnostic

Data Quality Control Living situation In campus 393 75.1

Clinical and Psychosocial Characteristics

submit your manuscript | www.dovepress.com

Powered by TCPDF (www.tcpdf.org)

(P-value less than 0.25) and were taken into a multivariable

rent cigarette use, and poor social support were found to

Variables Category Frequency Percentage

Powered by TCPDF (www.tcpdf.org)

finding. This could be linked with the fact that students in

(2014) with the prevalence of stress, 57.8%, and anxiety,

Sex Male 140 222 1 1 155 207 1 1

Living situation In campus 160 233 1 1 171 222 1 1

Marital status Married 21 36 1 1 32 25 1 1

Family history of suicidal attempt Yes 22 19 1.53(0.80–2.90) 1.10,(0.52–2.30) 26 15 1.90(0.98–3.70) 1.28(0.60–2.80)

Family history of mental illness Yes 31 26 1.60(0.92–2.80) 1.75(0.92–3.32) 36 21 1.92(1.10–3.38) 1.90(0.90–3.64)

Current alcohol use Yes 87 59 2.40(1.63–3.60) 2.28(1.50–3.50)** 82 64 1.50(1.02–2.20) 1.50(0.94–2.21)

Current khat use Yes 53 52 1.40,(0.90–2.13) 0.75(0.45–1.25)

Current cigarette use Yes 30 11 3.85(1.90–7.86) 3.50(1.58–7.73)* 24 17 1.52(0.80–2.90) 1.10(0.53–2.20)

Perceived social support Strong 43 65 1 1

Notes: *p<0.05 and **p<0.001.

submit your manuscript | www.dovepress.com

Powered by TCPDF (www.tcpdf.org)

Powered by TCPDF (www.tcpdf.org)

9. Rasheed AG, Hussein AG. Depression, anxiety, and stress among

or in all these areas; took part in drafting, revising or

submit your manuscript | www.dovepress.com

Powered by TCPDF (www.tcpdf.org)

matology among university students in Denizli, Turkey: prevalence

Neuropsychiatric Disease and Treatment Dovepress

Powered by TCPDF (www.tcpdf.org)

You might also like