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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 13  |  Issue : 1  |  Page : 55-58

Prevalence of perceived stress among clinical students of Bayero University Medical School


Department of Paediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria

Date of Web Publication12-Feb-2016

Correspondence Address:
M O Asani
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-8540.176209

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  Abstract 

Background: The academic and psychological demands of undergraduate medical education may result in high-stress levels among students. High stress has been associated with poor academic performance, negative impact on physical and mental health. This study aims to determine the prevalence of stress among undergraduate clinical students of Bayero University Kano Medical School. Materials and Methods: This was a cross sectional study conducted among 224 clinical medical students from levels 400–600. The Cohen's Perceived stress scale (PSS-10) was used to assess the severity of among the students. The Chi-square test was used to determine associations and a significant association was considered at P < 0.05. Results: A prevalence of high stress of 59.8% was observed with a mean PSS score of 20.76 ± 5.58. The highest mean score of 22.29 ± 5.58 was observed among 400 level clinical students. There was no significant difference between both genders. A significantly higher proportion of students undergoing medicine, pathology, paediatrics and surgery postings were observed to be experiencing a higher level of perceived stress compared to those in Obstetrics and Gynaecology, (χ2 = 1617, df = 4, P < 0.05). Similarly, a higher proportion of students whose fathers are educated had a significantly higher stress compared to their counterparts from uneducated backgrounds, (χ2 = 5.54, df = 1, P < 0.05). Conclusion: Further studies to determine the causes of stress need to be carried out. This will assist the students and teachers to appropriately manage stress.

Keywords: Kano, medical school, stress


How to cite this article:
Asani M O, Farouk Z, Gambo S. Prevalence of perceived stress among clinical students of Bayero University Medical School. Niger J Basic Clin Sci 2016;13:55-8

How to cite this URL:
Asani M O, Farouk Z, Gambo S. Prevalence of perceived stress among clinical students of Bayero University Medical School. Niger J Basic Clin Sci [serial online] 2016 [cited 2023 Mar 31];13:55-8. Available from: https://www.njbcs.net/text.asp?2016/13/1/55/176209


  Introduction Top


The term 'stress' was first described in the 1930's by the endocrinologist Hans Selye and refers to the sum of physical, mental and emotional strains or tensions on a person.[1] Similarly, it may also be described as the result of the failure of an organism, human or animal to respond appropriately to emotional or physical threats whether actual or imagined.[2]

High levels of stress may have a negative effect on physical and mental health, cognitive functioning and overall comprehension of individuals.[3] A significant association has been found between stress and sleep disturbances, eating habits (frequently missing breakfast), lack of physical exercise, alcohol consumption, smoking and drug consumption. Similarly, high stress is a risk factor for several chronic diseases including hypertension, diabetes and coronary artery disease [4],[5] The stressful academic atmosphere in medical colleges usually promotes competition among learners rather than cooperation. This may eventually impact negatively on the output of the individual doctor as well as on patient care as a whole. Medical and dental students in Ibadan Nigeria were observed to have higher stress scores than nursing and physiotherapy students.[6] Similarly, Ragaa et al.[7] observed a prevalence of high level of perceived stress of up to 71.5% among clinical medical students in Saudi Arabia but Solanki et al.[8] and Sharma et al.[9] documented a lower prevalence of 41.2% and 10% among undergraduate medical students in Surat, and postgraduate medical students in Delhi, respectively. The difference in prevalence is likely due to the different prevailing educational, environmental factors. Several studies have also reported a high prevalence of stress among residents in postgraduate medical education.[9],[10]

The Cohen perceived stress scale (PSS) measures the degrees to which life events are appraised as stressful.[11] This scale has become one of the most widely used psychological instruments for measuring perceived stress and has been translated into several languages including Spanish, Turkish, Japanese and Chinese.[4],[12] The PSS predicts objective markers of stress and increased the risk for diseases among persons with higher perceived stress levels. For example, higher stress suggests chronic stress with associated affectation of some markers and organ systems such as cortisol levels, immune system and wound healing.[13],[14],[15],[16]

This study aimed to determine the prevalence of stress among clinical medical students in Bayero University Kano, Nigeria. To the best knowledge of the researchers, a similar study has not been conducted in this environment. This will provide data that may be used to provide a stress-free training environment and will also prevent the development of chronic diseases among these students.


  Materials And Methods Top


The study was conducted among 400, 500 and 600 levels clinical medical students of Bayero University Medical School. Approval was sought from the Ethical Committee of the Aminu Kano Teaching Hospital Kano. Informed consent was also sought from the participants. All the clinical students were invited to participate. A self-administered questionnaire was used. Sociodemographic data collected include age, gender, level, marital status, postings and Parental education. The psychological instrument used to measure the degree of stress was the Cohen PSS-10. Participants were asked to respond to each question on a five-point scale ranging from 0 (never) to 4 (very often) including how often they have felt or thought a certain way within the past month. Scores ranged from 0 to 40 with higher scores indicative of higher stress. For the purpose of this study, scores ≥20 is considered as the high level of perceived stress.[17]

Data were entered into the excel sheet and was analysed using the mini tab. For descriptive statistics, frequency distribution and calculation of mean and standard deviation were done. The Chi-square test was used to determine associations and significant association was considered at P < 0.05.


  Results Top


A total of 224 clinical students responded, out of a total of 281 students giving a response rate of 79.7%. Their ages ranged from 21 to 33 years. Many of them 132 (58.9%) belonged to the age range of 21–25 years. There were more males than females with a male to female ratio of 2.5:1. All the students were from levels 400–600 with a similar distribution of students in all the levels (40%, 33% and 33%, respectively). Most of them were single 195 (87.1%). This is as illustrated in [Table 1].
Table 1: Sociodemographic features of respondents

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The prevalence of highly perceived stress (PSS of ≥20) among Bayero University Clinical Medical Students was found to be 59.8% (134/224) with an overall mean PS score of 20.76 ± 5.58. The highest mean PS score was observed among female students (21.31 ± 5.7) and the 1st year clinical students ([400 level] 22.29 ± 5.58). This is as shown in [Table 2].
Table 2: Mean perceived stress scale by level and gender

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[Table 3] below shows that the distribution of students experiencing high level of stress in the different age groups and gender was found to be similar. However, a significantly higher proportion of students undergoing medicine, pathology, paediatrics and surgery postings were observed to be experiencing a higher level of perceived stress compared to those in O and G (χ2 = 16.17, df = 4, P < 0.05). Similarly, a significantly higher number of students with educated fathers experience high level of stress than those from uneducated backgrounds (χ2 = 5.54, df = 1, P < 0.05). Age, gender, marital status and source of funding were not found to affect the prevalence of a high level of stress among the students (P > 0.05).
Table 3: Factors associated with high stress

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The differences in high level of stress between students of employed and unemployed parents were not found to be statistically significant (P > 0.05). This is shown in [Table 4].
Table 4: Prevalence of high stress compared with parental occupational status

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  Discussion Top


The mean PSS score of 20.76 ± 5.58 in this study is similar to the mean value among 1st year medical students described by Thangaraj and D'souza [18] in Bengaluru, India (PSS score of 20.29 ± 6.24). This level is indicative of high-stress level.[17] The high stress level was also observed among medical students and dental students by Omigbodun et al.[6] when compared to physiotherapy and nursing students in Lagos, South-Western Nigeria. The relatively high level of stress may be related to common stressors in medical schools such as heavy academic workload, intense pace of training, lack of leisure time, frequent formative assessment (ward rounds and clinics), few holiday periods, financial difficulties, insecurity time pressure and uncertainty of the academic calendar among others.[6]

The highest mean score of 22.29 ± 5.58 observed in the 400 level students (1st year clinical students) in this study may be attributable to the change in curriculum content from mainly didactic lectures and practical classes to bedside teaching, ward rounds with its attendant formative assessment. This finding is in contrast to what was observed by Ragaa et al.[7] where stress was higher among final year (600 level) medical students in Saudi Arabia. Similarly, in a study on perceived level of stress in Nigerian Dental Students in Lagos, Sofola and Jeboda [19] observed a higher stress levels among the final year medical students (600 level) with all of them (100%) having high stress. The anxiety associated with the upcoming final exams is probably attributable and postgraduation challenges.

In this study, there was no statistically significant mean PSS score between the female and male medical students. This finding is consistent with several other studies using different tools for assessing stress.[20],[21] The reason why there was no gender difference in the mean PSS remains obscure considering the different emotional and genetic differences between both genders.

In this study, it was observed that only differences in postings and paternal educational status significantly affected the prevalence of high stress. A significantly fewer number of students in Obstetrics and Gynaecology postings experience high stress compared to other clinical postings. The reasons why the students undergoing posting in Obstetrics and Gynaecology have a lower mean perception of stress is unclear. Possible reasons may include narrower curriculum content, higher pass rate or friendly disposition of the teaching staff. A future study is required to confirm or refute these reasons. Similarly, a significantly higher number of students with educated fathers experience high stress compared to those from uneducated backgrounds. This may be due to the higher expectation of educated fathers of their children to perform well.

Several limitations peculiar to a questionnaire based study are acknowledged such as the dependence on memory for recall in the last 4 weeks, honesty and the subjective perception of stress in responding to the questions, all of which may affect the outcome of this study.


  Conclusion Top


The high prevalence of stress among clinical medical students of Bayero University is worrisome. There is the need for further studies to evaluate the causes of stress among these students. Identification of these factors will assist the students and faculty to take appropriate steps to combat the stress. It is evident from the findings of this study that the clinical students will benefit from adequate social and psychological support from the teaching and nonteaching staff of the faculty. Adequate counselling should be provided to prevent future mental and physical illnesses due to severe stress.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Goldberger L, Breznitz S. Handbook of Stress: Theoretical and Clinical Aspects. New York: Free Press; 1982. p. 987.  Back to cited text no. 1
    
2.
Selye H. The stresses of life. New York: McGraw Hill; 1956. p. 1523-67.  Back to cited text no. 2
    
3.
Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: A cross-sectional study. Med Educ 2005;39:594-604.  Back to cited text no. 3
    
4.
Cohen S, Williamson G. Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S, editors. The Social Psychology of Health. Newbury Park, CA: Sage; 1998.  Back to cited text no. 4
    
5.
Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012;33:1635-701.  Back to cited text no. 5
    
6.
Omigbodun OO, Odukogbe AT, Omigbodun AO, Yusuf OB, Bella TT, Olayemi O. Stressors and psychological symptoms in students of medicine and allied health professions in Nigeria. Soc Psychiatry Psychiatr Epidemiol 2006;41:415-21.  Back to cited text no. 6
    
7.
Ragaa EM, Seba MG, Randah MH, Ahmed MA, Tarek S. Perceived stress and burnout among medical students during the clinical period of their education. Ibnosina J Med Biomed Sci 2013;5:179-88.  Back to cited text no. 7
    
8.
Solanky P, Binita D, Abhay K, Kantharia SL. Study of psychological stress among undergraduate medical students of government college, Surat. Int J Med Sci Public Health 2012;1:38-42.  Back to cited text no. 8
    
9.
Sharma B, Prassad S, Pandey R, Singh J, Sodhi KS, Wadhwa D. Evaluation of stress among postgraduate medical and dental students: A pilot study. Delhi Psychiatry J 2013;16:312-6.  Back to cited text no. 9
    
10.
Issa BA, Yusuuf AD, Olanrewaju GT, Oyewole AO. Stress in residency training as perceived by resident doctors in a Nigerian university teaching hospital. Eur J Sci Res 2009;30:253-9.  Back to cited text no. 10
    
11.
Chen CH, Tseng YF, Chou FH, Wang SY. Effects of support group intervention in postnatally distressed women. A controlled study in Taiwan. J Psychosom Res 2000;49:395-9.  Back to cited text no. 11
    
12.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385-96.  Back to cited text no. 12
    
13.
Malarkey WB, Pearl DK, Demers LM, Kiecolt-Glaser JK, Glaser R. Influence of academic stress and season on 24-hour mean concentrations of ACTH, cortisol, and beta-endorphin. Psychoneuroendocrinology 1995;20:499-508.  Back to cited text no. 13
    
14.
Pruessner JC, Hellhammer DH, Kirschbaum C. Burnout, perceived stress, and cortisol responses to awakening. Psychosom Med 1999;61:197-204.  Back to cited text no. 14
    
15.
Van Eck MM, Nicolson NA. Perceived stress and salivary cortisol in daily life. Ann Behav Med 1994;16:221-7.  Back to cited text no. 15
    
16.
Maes M, Van Bockstaele DR, Gastel A, Song C, Schotte C, Neels H, et al. The effects of psychological stress on leukocyte subset distribution in humans: Evidence of immune activation. Neuropsychobiology 1999;39:1-9.  Back to cited text no. 16
    
17.
Burns VE, Drayson M, Ring C, Carroll D. Perceived stress and psychological well-being are associated with antibody status after meningitis C conjugate vaccination. Psychosom Med 2002;64:963-70.  Back to cited text no. 17
    
18.
Thangaraj S, D'Souza L. Prevalence of stress levels among first year medical undergraduate students. Int J Interdiscip Multidiscip Stud 2014;1:176-81.  Back to cited text no. 18
    
19.
Sofola OO, Jeboda SO. Perceived sources of stress in Nigerian dental students. Eur J Dent Educ 2006;10:20-3.  Back to cited text no. 19
    
20.
Koochaki GM, Charkazi A, Hasanzadeh A, Saedani M, Qorbani M, Marjani A. Prevalence of stress among Iranian medical students: A questionnaire survey. East Mediterr Health J 2011;17:593-8.  Back to cited text no. 20
    
21.
Amr M, Hady El Gilany A, El-Hawary A. Does gender predict medical students' stress in Mansoura, Egypt? Med Educ Online 2008;13:12.  Back to cited text no. 21
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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