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Year : 2015  |  Volume : 12  |  Issue : 2  |  Page : 81-85

Psychological distress due to academic stress among clinical students in a Nigerian tertiary institution: Comparison between medical and physiotherapy students

1 Department of Medical Services, Federal Neuropsychiatry Hospital, Barnawa-Kaduna, Nigeria
2 Department of Physiotherapy, Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Clinical Services, Federal Neuropsychiatry Hospital, Kware, Sokoto, Nigeria

Date of Web Publication10-Nov-2015

Correspondence Address:
Tajudeen Abiola
Federal Neuropsychiatry Hospital, Barnawa-Kaduna
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0331-8540.169298

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Introduction: Studies of psychological distress among university students identified academic stress as highest in medical students followed by allied-health students and least in those not in any of these two disciplines. The immediate antecedents include poor academic performance, substance abuse, and subsequent drop out. Future impacts as burnouts and poor services delivery can be exorbitant. This study therefore aimed to document the prevalence of psychological distress among two groups of clinical students of College of Medicine, Bayero University Kano. And also report influence of demographics, resilience and social support on the observed prevalence. Methodology: The participants were 122 clinical students from two departments of clinical sciences that is, medicine and physiotherapy. All gave consent before administration of the study instruments consisting of sociodemograhic questionnaire, Hospital Anxiety Depression Scale (HADS), Resilience Scale (RS) and Oslo Social Support Scale (OSS-3). Results: Overall, 63.1% of participants were males while 57.4% were females. The mean age of medical versus physiotherapy students are respectively 22.47 years and 22.17 years. Psychological distress as measured by HADS is higher in medical students (depression [57.4%] and anxiety [61.6%]) compared to physiotherapy students (depression [42.6%] and anxiety [38.4%]). Physiotherapy students had higher resilience and lower social support compared to medical students. The participants' mean scores on HADS, RS, and OSS-3 is only statistically significant for the RS. Conclusion: It was noted that psychological distress due to academic stress is more among Medical students compared to physiotherapy students. Interventions strengthening social support and improving resilience should be included as part of students' training.

Keywords: Psychological distress, medical and physiotherapy students, resilience, social support

How to cite this article:
Abiola T, Lawal I, Habib ZG. Psychological distress due to academic stress among clinical students in a Nigerian tertiary institution: Comparison between medical and physiotherapy students. Niger J Basic Clin Sci 2015;12:81-5

How to cite this URL:
Abiola T, Lawal I, Habib ZG. Psychological distress due to academic stress among clinical students in a Nigerian tertiary institution: Comparison between medical and physiotherapy students. Niger J Basic Clin Sci [serial online] 2015 [cited 2021 Jun 23];12:81-5. Available from: https://www.njbcs.net/text.asp?2015/12/2/81/169298

  Introduction Top

Psychological distress is a fundamental component of mental illness, characterized by absence of emotional and social wellbeing.[1] Broadly, psychological distress is defined as a disturbance of the mood state characterized by features of depression and anxiety.[1] These features had been the focus of measure in several studies on mental distress experience by medical [2],[3],[4] and paramedical students.[5],[6] Studies agreed that medical and allied health professions' education and training are stressful [2],[3],[4],[5],[6] with social and financial strains compounding the psychological distress.[2],[7] Furthermore, studies also suggested that all levels of training are very stressful but emphasized that the first preclinical year and first clinical year are particularly demanding.

While both medical and paramedical students are reported to experience psychological stress comparison between them suggested that more distress are experienced among the medical students compared to the paramedical students.[7],[8] Studies investigating psychological distress among other nonmedical/paramedical university students also reported high stress among such group of students.[8],[9] However, the reported prevalence in these university students is usually lower compared to those in the medical/paramedical discipline. This may not be unconnected to the higher degree of stress related to medical and paramedical training.[2],[3],[4],[5],[6]

Irrespective of the university students' group, psychological distress appears to limit academic performance, contributes to substance abuse, and subsequent drop out of school.[2],[4],[9] Specifically, psychological distress may affect medical and perhaps paramedical training thereby making them less rewarding personally and socially meaningless.[2] The future impacts on health practitioners as burnouts [2],[4] and on patients care as poor services can be exorbitant. Thus, the need to enhance students' wellbeing and consequently future positive professionalism cannot be overstated. We investigated the concept of psychological distress among medical and paramedical students in a Nigerian tertiary institution. First this study aimed to document the prevalence of psychological distress among two groups of clinical students in Aminu Kano Teaching Hospital. Secondly, it will test the influence of demographic, resilience and social support variables on the observed prevalence.

  Methodology Top


The participants were 122 4th and 5th year clinical students from two departments of clinical sciences, College of Medicine (COM) of Bayero University Kano that is, the departments of medicine and physiotherapy. They were recruited by convenience from these two departments of the COM with a minimum sample size of total 100 students that is, 50 from each department. The minimum sample size of 100 was determined by Raosoft Inc., online sample size calculator,[10] at 50% response distribution, 95% confidence interval and 9.78% margin of error.[10] All participants gave consent before the administration of the study instruments.


The study utilized questionnaire that comprised of two parts. The first part collects information on sociodemographic characteristics of the participants (academic level, age, gender and marital status). The second portion contains measuring scales of psychological distress (i.e., a disturbance of the mood state characterized by features of depression and anxiety),[1] resilience (i.e. a psychological process developed in response to intense life stressors that facilitates healthy functioning)[11] and social support (i.e. the physical and psychological comfort provided by other people).[12] The psychological distress is measured by Hospital Anxiety Depression Scale (HADS), resilience by Resilience Scale (RS) and social support by Oslo 3-item Social Support Scale (OSS-3).

Hospital anxiety depression scale

The HADS is a portable and an easy to administer measure of anxiety or depressive state in both clinical and nonclinical population. It consists of seven depression items and seven anxiety items and has been validated for use in Nigeria.[13] A score of 8 and above on either of the two components is regarded as a case. Both the depressive and anxiety subscales were used in this study.

Resilience Scale

The RS is a measure of psychological resilience and it consists of 25-item.[14] The RS and its short form (RS-14) have good validity and reliability (Cronbach's α range of 0.72–0.94) from several western studies.[15],[16] Both instruments had also been validated for use in Nigeria by Abiola and Udofia [17] (Cronbach's α for RS and RS-14 were 0.87 and 0.81 respectively). Both instruments (RS and RS-14) are scored on a likert scale of 1–7 yielding scores that grouped participants into: Low, moderate and high resilience scores. In this study, the 25-item original scale was utilized to report the resilient characteristics of the participants.

The oslo 3-items social support scale

The OSS-3 provides a brief measure of social functioning and it is considered to be one of the best predictors of mental health.[18] It covers different fields of social support by measuring the number of people the respondent feels close to, the interest and concern shown by others, and the ease of obtaining practical help from others.[19] Its structure and reliability (Cronbach's alpha of 0.60)[20] have not been well-documented despite widespread use in several European countries. Nonetheless, its brevity and the availability of normative data are strong considerations.[21] It has been validated for use in Nigeria.[22]

Data analysis

All data are analysed using IBM-SPSS version 21. Frequency tables were used to show the distribution of the prevalence and sociodemographics of the participants. Student t-test was carried out to determine participants' mean scores based on their psychological distress, resilience characteristics and social support. All results were determined as significant if the P < 0.05, two tailed.

  Results Top

[Table 1] shows that medical students made up 57.4% (70) of the participants and the remaining 42.6% (52) are physiotherapy students. The mean age of medical and physiotherapy students are 22.47 years (standard deviation = 0.61) and 22.17 years (standard deviation = 0.55) respectively. Overall, 63.1% (77) of participants are males and 36.9% (45) are females. Most of the male participants (61%) are from the department of Medicine and majority of the females (51.1%) are studying physiotherapy. More than two-third of the participants in their 4th year are studying medicine and about a similar proportion in 500 level are from physiotherapy department. Among the married students, 75% are studying medicine.
Table 1: Sociodemographic distribution of participants according to course of study

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In [Table 2], majority of those with psychological distress using HADS subscales are medical students that is, 57.5% accounting for depression subscale and 61.6% for the anxiety subscale. Furthermore, the outcome based on the corresponding mean scores of the psychological distress showed that the physiotherapy students depicted higher mean total scores on both subscales of HADS. However, detected cases according to the two subscales of HADS indicated that the medical students have higher mean score of distress [Table 3]. Similarly, physiotherapy students had a statistically significant higher mean total resilience score than medical students. However, among the specific identified cases on the two subscales of HADS, there was no statistically significant differences between the two categories of students studied that is, resilience among cases presenting with anxiety or depression is statistically insignificant between the two categories of students. In terms of social support, medical students recorded more overall nonsignificant mean scores compared to physiotherapy students. Similar nonsignificant observations were noted among the participants screened as cases on the two subscales of HADS.
Table 2: Prevalence of psychiatric morbidity among the participants based on their HADS score and course of study

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Table 3: Mean scores of participants' psychological characteristics according to their course of study

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  Discussions Top

Our study reported that the prevalence of psychological distress as measured by the two subscales of HADS is higher among medical students compared to physiotherapy students. This study agrees with previous findings that academic stress is more in medical students.[7],[8],[9] However, one study specifically looking at depressive cases between medical and physiotherapy students found depression to be more among the latter.[23] This may not be unconnected to the very low representation of males among that study physiotherapy students.[23] However, the reported prevalence in our two categories of students is higher than that reported in a national survey among the Nigerian adult population.[24] Although, the Nigerian survey used diagnostic instruments and our study utilized screening instrument.

The total mean distress levels are more among physiotherapy students compared to medical students. However, these mean scores are not statistically significant and fell into the noncase category range of the HADS. Among the cases on the other hand, the mean distress levels on both subscales are higher in medical students compared to physiotherapy students. This may signify the position of previous studies in which medical students were found to had higher psychological distress compared to allied health students.[7],[8] The high psychological distress as shown by medical students could be accounted for by their poor resilience compared to their counterpart in physiotherapy who depicted an overall significant level of resilience above the medical students. The nonsignificant mean resilience scores of the distressed cases on both subscales of HADS may suggest the weight of academic burden in the two categories of students is relatively close. Future impacts on professionalism may be great as the participants' resilience levels falls into the moderate range designation of the RS. Hence more burnout may be expected in future physicians slightly higher than in allied health professionals.[2],[4]

The impact of social support on this is also noted. Although not significant, physiotherapy students had slightly less mean social support characteristics than medical students. Overall, the mean social support characteristics of the participants fall into the upper medium range and may contribute to why none of the participants come down with clinical depression and/or anxiety in this study. This tallied with positive effect of social support as health promotive in various life situations and buffers to the untoward effects of stressors that any individual may be going through.[19],[20],[22]

  Limitations Top

The outcome of this study should be interpreted with caution especially because only screening tools were used to measure psychological distress in the study. A longitudinal study will be needed to correlate related variables like social support and resilience effects over time. The noninclusion of preclinical students and participants being restricted to College of Medicine of one institution may limit application of these findings to students of other medical and allied health training institutions. Finally, other sources of distress (like change from preclinical to clinical session for those in 4th year; disproportional representation of participants based on years of study and departments; marital challenges among the married; burden of being divorced, separated or widowed among the singles; ongoing loss; and secondary trauma associated with clinical practices) apart from academic stress could have contributed to the psychological distress and were not explored in this study.

  Conclusion Top

This study concluded that psychological distress due to academic stress is high in among our study participants with medical students exhibiting greater psychological distress above physiotherapy students. Interventions like strengthening social support and improving resilience should be included as part of interventions for all students to help reduce the prevalence of psychological distress. Success in such approach will limit future professional practice distress like burnout and its related impacts.

  References Top

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  [Table 1], [Table 2], [Table 3]

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