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Prevalence of Stressors among Female Medical Students Taibah University
STUDENT SECTION
Prevalence of Stressors among Female Medical Students Taibah University Kholoud Abdulrahman Habeeb Final Year Medical Student, College of Medicine, Taibah University Al Madinah Al Munawarah Kingdom of Saudi Arabia
Abstract
Objectives A stressor is defined as a personal or environmental event that causes stress. Studies have revealed that the stressors affecting medical students’ well-being seem to be related to the medical training, especially academic matters. Present study looks into the prevalence of various stressors among female medical students, Taibah University Al Madinah Al Munawarah Saudi Arabia. Methods A cross sectional survey was conducted for all female medical students. The Medical Students Stressor Questionnaire (MSSQ) was used. The response rate was 89.7% (305/340). Statistical analysis was done using percent, mean, standard deviation, Fisher's Exact test, and Kendall's correlation. Results The mean age of the studied students was 21.4±2.34 years. Their mean score was 3.9±0.73.Nearly half (46.2%) of students had high academic related stress, 50.2% had moderate interpersonal stress, 52.8% had moderate teaching and learning related stress. Nearly two thirds (59.7%) had moderate social related stress, 40.7% had moderate desire related stress and 54.1 had moderate group activity related stress. There were correlation between students score and academic (r=-0.120, p=0.036), interpersonal stress (r=-0.100, p=0.027), desire related stress (r=-0.116, p=0.011) and group activity related stress (r=-0.171, p=0.000). Conclusion The predominant forms of stressors which were found among female medical students were social, teaching and learning, interpersonal and group activities related stressors. All forms of stressors became more obvious in clinical years. Stressors were negatively correlated to students' score. Key Words: Stressors, Medical, Students, MSSQ. Journal of Taibah University Medical Sciences 2010; 5 (2): 110 - 119
Correspondence to: Kholoud Abdulrahman Habeeb Fifth year medical student, Medical College, Taibah University
30001, Al Madinah Al Munawarah, Kingdom of Saudi Arabia +966 48460008 +966 48461407 [email protected] 110
Kholoud Abdulrahman Habeeb
Introduction
Students Stressor Questionnaire (MSSQ) was used. The purpose, of the study was explained to the respondents and a verbal informed consent was obtained. Ethics Review Committee reviewed and approved the proposal. The MSSQ grouped stressors into six domains: Academic related stressors (ARS), Intrapersonal and interpersonal related stressors (IRS), Teaching and learningrelated stressors (TLRS), Social related stressors (SRS), Drive and desire related stressors (DRS) and Group activities related stressors (GARS)16. Mild score denoting that it does not cause any stress. Even if it does, it just causes mild stress. Moderate score indicates that it reasonably causes stress. However it can be managed well. High score indicates that it causes a lot of stress. The emotions seem to be disturbed by it. The daily activities are mildly compromised due to it. Sever score indicates that it severely causes stress. It disturbs emotions badly. The daily activities are compromised due to it. Data about the age in years, score gained previous year, current university year, and marital status was obtained.
S
tress is emotional disturbances or changes caused by stressors. Stress is defined as the body's nonspecific response or reaction to demands made on it, or to disturbing events in the environment1,2. It is not just a stimulus or a response but it is a process by which we perceive and cope with environmental threats and challenges3. Personal and environmental events that cause stress are known as stressors4,5. Linn & Zeppa stated that some stress in medical school training is needed for learning. Stress which promotes and facilitates learning is called ‘favourable stress’ and stress which inhibits and suppresses learning is called ‘unfavourable stress’6. The same stressors may be perceived differently by different medical students, depending on their cultural background, personal traits, experience and coping skills6. Tertiary education has always been regarded as highly stressful environment to students7,8. Medical training further adds to the already stressful environment. Studies have revealed a high prevalence of stress in medical students, ranging from 30% to 50%712. The alarming facts suggested a situation of elevated psychological pressure on medical students. A small number of medical students suffer from personal problems, but the effect of this on student psychological morbidity and academic success is unclear8,13. Curriculum differences in medical schools may not necessarily cause differences in the overall pattern of stressors (i.e. most of the top stressors are related to academic matters), although frequency (rank) of some stressors may be significantly different14,15. The present study examined prevalence of various stressors among female medical students, Taibah University, Saudi Arabia, in year 2010.
Statistical Analysis Data was entered and analyzed using SPSS version 13.0. Means (± SD) were computed for continuous and proportions for categorical variables. Kendall's Correlation was used to find out the relation between students' score and various stressors. Fisher's Exact test was used, and 95% significance level was chosen.
Results This survey had a response rate of 89.7% (305/340). The mean age of studied students was 21.4±2.34 years. Their mean score was 3.9±0.73. Only 9.2% (28/305) was married. Nearly half of students had ARS (46.2%); 20.6% of them were enrolled in the fifth years. Sever ARS constituted 6.6% and 60.0% of its cases found in fifth year followed by fourth year (30.0%). There was a statistical significant
Materials and Methods A cross sectional survey was conducted for all female medical students. The Medical
111 J T U Med Sc 2010; 5(2)
Prevalence of stressors among female medical students
difference between classes (p=0.000) as demonstrated in Table 1. Half of the studied students had IRS (50.2%); 25.5% of them from second year. Regarding the sever form of IRS, 46.7% was enrolled in the fifth year. There was a statistical significant difference between classes (p=0.014) shown in Table 2. Moderate form of TLRS were encountered among 52.8%; with a significant difference between classes (p=0.027). Sever form formed 3.9%; of which 41.7% were in the fifth year (Table 3). More than half (59.7%) of studied students had moderate SRS; with insignificant statistical difference between classes. Nearly three quarters (72.7%) of second year medical students having it. More than half of sever SRS (55.6) was encountered among fifth year medical students (Table 4). Moderate (40.7%) and mild (40.3%) DRS were the prevalent one; with a statistical
significant difference between classes (p=0.010). Sever form constituted 2.6% and 75.0% of its cases were in fifth year medical students (Table 5). Moderate GARS was found among 54.1% of students; with a significant difference between classes (p=0.000). Moreover, more than two thirds of sever form of GARS (66.7%) were among fifth year medical students (Table 6). Generally speaking, all stressors were more prevalent among clinical years (3rd, 4th and 5th year) than academic one (1st and 2nd), as shown in Figure 1. There were correlation between students score and academic (r=-0.120, p=0.036), interpersonal stress (r=-0.100, p=0.027), desire related stress (r=-0.116, p=0.011) and group activity related stress (r=-0.171, p=0.000) as outlined in Table 7.
GARS DRS
40.4% 37.9%
SRS
44.3%
TLRS
42.3%
IRS
40.6%
ARS
42.3%
59.6% 62.1% 55.7% Clinical Years
57.7%
Academic Years
59.4% 57.7%
Figure 1: Prevalence of stressors according to year.
112 J T U Med Sc 2010; 5(2)
Kholoud Abdulrahman Habeeb
Table 1: Relation between academic related sressors and grade Mild No
Moderate
High
Severe
Total
%
No
%
No
%
No
%
N
%
1st Year
3
42.9/4.7
35
25.5/54.7
26
18.4/40.6
0
0.0/0.0
64
21.0/100.0
2nd Year
1
14.3/1.5
32
23.4/48.5
32
22.7/48.5
1
5.0/1.5
66
21.6/100.0
3rd Year
0
0.0/0.0
33
24.1/55.0
26
18.4/43.3
1
5.0/1.5
60
19.7/100.0
4th Year
2
28.6/3.4
23
16.8/39.0
28
19.9/47.5
6
30.0/10.2
59
19.3/100.0
5th Year
1
14.3/1.8
14
10.2/25.0
29
20.6/51.8
12
60.0/21.4
56
18.4/100.0
Total
7
100.0/2.3
137
100.0/44.9
141
100.0/46.2
20
100.0/6.6
305
100.0/100.0
P
0.003
Table 2: Relation between interpersonal related stressors and grade Mild
Moderate
High
Severe
Total
N
%
N
%
N
%
N
%
N
%
1st Year
22
33.3/34.3
31
20.3/48.4
10
14.1/15.6
1
6.7/1.6
64
21.0/100.0
2nd Year
11
16.7/16.7
39
25.5/59.1
15
21.1/22.7
1
6.7/1.5
66
21.6/100.0
3rd Year
13
19.7/21.7
34
22.2/56.7
10
14.1/16.7
3
20.0/5.0
60
19.7/100.0
4th Year
11
16.7/18.6
27
17.6/45.8
18
25.4/30.5
3
20.0/5.1
59
19.3/100.0
5th Year
9
13.6/16.1
22
14.4/39.3
18
25.4/32.1
7
46.7/12.5
56
18.4/100.0
Total
66
100.0/21.6
153
100.0/50.2
71
100.0/23.3
15
100.0/4.9
305
100.0/100.0
P-value
0.014*
* p-value is significant at level <0.05
113 J T U Med Sc 2010; 5(2)
Kholoud Abdulrahman Habeeb
Table 3: Relation between teaching and learning related stressors and grade Mild
Moderate
High
Severe
Total
N
%
N
%
N
%
N
%
N
%
1st Year
10
30.3/15.6
35
21.7/54.7
18
18.2/28.1
1
8.3/1.6
64
21.0/100.0
2nd Year
5
15.2/7.6
38
23.6/57.6
21
21.2/31.8
2
16.7/3.0
66
21.6/100.0
3rd Year
8
24.2/13.3
40
24.8/66.7
12
12.1/20.0
0
0.0/0.0
60
19.7/100.0
4th
Year
6
18.2/10.2
23
14.3/39.0
26
26.3/44.1
4
33.3/6.8
59
19.3/100.0
5th Year
4
12.1/7.1
25
15.5/44.6
22
22.2/39.3
5
41.7/8.9
56
18.4/100.0
Total
33
100.0/10.8
161
100.0/52.8
99
100.0/32.5
12
100.0/3.9
305
100.0/100.0
P-value
0.027*
* p- value is significant at level <0.05 Table 4: Relation between social related stressors and grade Mild
Moderate
High
Severe
Total
N
%
N
%
N
%
N
%
N
%
1st Year
11
21.2/17.2
39
21.4/60.9
13
21.0/20.3
1
11.1/1.6
64
21.0/100.0
2nd Year
7
13.5/10.6
48
26.4/72.7
10
16.1/15.2
1
11.1/1.5
66
21.6/100.0
3rd Year
13
25.0/21.7
35
19.2/58.3
11
17.7/18.3
1
11.1/1.7
60
19.7/100.0
4th Year
11
21.2/18.6
33
18.1/55.9
14
22.6/23.7
1
11.1/1.7
59
19.3/100.0
5th Year
10
19.2/17.9
27
14.8/48.2
14
22.6/25.0
5
55.6/8.9
56
18.4/100.0
Total
52
100.0/17.0
182
100.0/59.7
60
100.0/20.3
9
100.0/3.0
305
100.0/100.0
P-value
0.192
* p- value is significant at level <0.05
114 J T U Med Sc 2010; 5(2)
Kholoud Abdulrahman Habeeb
Table 5: Relation between drive and desire related stressors and grade Mild
Moderate
High
Severe
Total
N
%
N
%
N
%
N
%
N
%
1st Year
24
19.5/37.5
31
25.0/48.4
9
18.0/14.1
0
0.0/0.0
64
21.0/100.0
2nd Year
37
30.1/56.1
22
17.7/33.3
7
14.0/10.6
0
0.0/0.0
66
21.6/100.0
3rd Year
26
21.1/43.3
26
21.0/43.3
8
16.0/13.3
0
0.0/0.0
60
19.7/100.0
4th Year
19
15.4/32.2
24
19.4/40.7
14
28.0/23.7
2
25.0/3.2
59
19.3/100.0
5th Year
17
13.8/30.4
21
16.9/37.5
12
24.0/21.4
6
75.0/10.7
56
18.4/100.0
Total
123
100.0/40.3
124
100.0/40.7
50
100.0/16.4
8
100.0/2.6
305
100.0/100.0
Pvalue
0.010*
* p- value is significant at level <0.05 Table 6: Relation between group activities related stressors and grade Mild
Moderate
High
Severe
Total
N
%
N
%
N
%
N
%
N
%
1st Year
16
35.6/25.0
37
22.4/57.8
11
14.3/17.2
0
0.0/0.0
64
21.0/100.0
2nd Year
9
20.0/13.6
43
26.1/65.2
13
16.9/19.7
1
5.6/1.5
66
21.6/100.0
3rd Year
15
33.3/25.0
28
17.0/46.7
17
22.1/28.3
0
0.0/0.0
60
19.7/100.0
4th Year
3
6.7/5.1
34
20.6/57.6
17
22.1/28.8
5
27.8/8.5
59
19.3/100.0
5th Year
2
4.4/3.6
23
13.9/41.1
19
24.7/33.9
12
66.7/21.4
56
18.4/100.0
Total
45
100.0/14.8
165
100.0/54.1
77
100.0/25.2
18
100.0/5.9
305
100.0/100.0
P-value
0.000*
* p- value is significant at level <0.05
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Prevalence of stressors among female medical students
Table 7: Correlation between students score and various stressors Correlation Coefficient -Academic related stressor -0.120* -Interpersonal related stressor -0.100* -Teaching and learning related stressor -0.070 - Social related stressor 0.004 - Derive and desire related stressor -0.116* - Group related stressor -0.171** *Correlation is significant at the 0.05 level (two tailed). ** Correlation is significant at the 0.01 level (two tailed).
Discussion
Significance 0.036 0.027 0.128 0.938 0.011 0.000
Half of studied students (50%) had IRS. Interpersonal stressors generally relate to relationships between individuals including as verbal, physical and emotional abuse caused by other persons, and conflict with personnel, teachers, colleagues, and staff16. More than half of studied students (52%) had moderate form of TLRS. A high score in this domain indicates that teaching and learning events are the main sources of stress. Consequently, it indicates that teaching and learning activities in the institution are unfriendly to students. This requires looking at components of teaching and learning process to determine the causes of stress on the students16. Nearly two thirds (59%) had Social Related Stressors referred to any form of community and societal relationships that cause stress. It generally relates to leisure time with family and friend, working with the public, private time for own self, working interruption by others, and facing patients’ problems. A high score in this domain indicates that societal and community events are the main sources of stress. This indirectly indicates that students have difficulty spending their time in social and community activities. Drive and desire related stressors refer to any form of internal or external forces that influence one’s attitude, emotion, thought and behavior which subsequently cause stress. It generally relates to unwillingness to study medicine due to various reasons such as not being one’s choice to study it, wrongly choosing the course, being demotivated after knowing the reality of medicine, parental wish to study medicine, and following friends to study medicine16.
Stress is defined as the body's nonspecific response or reaction to demands made on it, or to disturbing events in the environment1, 2. Tertiary education has always been regarded as highly stressful environment to students7, 8. Medical training further adds to the already stressful environment. This study shows that the prevalence of stressors ranged from 37.9-62.1%; which were higher than other performed studies (30-50%)7-12. The same stressors may be perceived differently by different medical students, depending on their cultural background, personal traits, experience and coping skills13. This alarming fact suggests a situation of elevated psychological pressure on female medical students. Academic related stressors refer to any scholastic, university, college, educational or student events that cause stress on students. These include examination systems, assessment methods, grading methods, academic schedule, student activities related to academic events such as getting poor marks in examinations, high-self expectation to do well in studies, large amount of content to be studied, having difficulty to understand content, lack of time to do revision, learning context full of competition, and having difficulty to answer questions given by teachers. This study shows that 46.2% had high ARS. A high score in this domain indicates that academic matters are the main sources of stress. Many studies have reported that the major stressors of medical students were academic related14, 15.
116 J T U Med Sc 2010; 5(2)
Kholoud Abdulrahman Habeeb
Fortunately, this domain had the lowest prevalence (40.7% of moderate form). Group activities related stressors refer to any group events and interactions that cause stress. It generally relates to participation in group discussions, group presentations and others expectations to do well. More than half (54.1%) of students had moderate form of GARS. According to the multicenter study mentioned above, those who perceived it as causing moderate stress have 2 times higher risk to develop distress compared to those who perceived it as causing mild to moderate stress16. Chronic exposure to stressful conditions exerts negative effects on emotional, mental and physical well-being of students. Numerous studies have revealed that persistent stressful conditions were associated with mental and physical health problems in medical students at various stages of their training7, 21. Studies have reported an association of excessive stress level with lowered medical students’ selfesteem6, 17, anxiety and depression18, 19, difficulties in solving interpersonal conflicts20, sleeping disorders21, 22, increased alcohol and drug consumption23-25, cynicism, decreased attention, reduced concentration and academic dishonesty13. It is also associated with inhibition of students’ academic achievement and personal growth development6. Excessive stress was also linked with medical student suicide26. As a result, medical students may feel inadequate and unsatisfied with their career as a medical practitioner in the future7, 8, 27. Long-term exposure to stress can lead to serious health problems. It can predispose to hypertension, diabetes mellitus, obesity, skin disorders, impairment of immune system, infertility, anxiety, depression, digestive problems, etc. Body response to stress varies according to individual predisposition28, 29.
stressors. All forms of stressors became more obvious in clinical years. Stressors were negatively correlated to students' score. Recommendations Planning of an intervention stressors prevention program is needed to be implemented for all students to prevent possible physical disorders resulting from stressors. Continuous supervision of students by the university' academic supervisor is needed to detect any abnormality that could be attributed to stressors. Creation of a student commeasure affair; with an active role that will represent the students with all their problems and also will plan for student social activities are mandatory. Strengthening the bonds and trust between the students and staff are needed to dissolve any barriers and minimize the stressful environment that may be found in the faculty environment. Further researches are needed to study in depth precipitating factors for each type of stressors. Study Limitations Inclusion of male students to compare them with females was supposed to be done but that was not feasible due to various logistics, communication and personnel issues. Timing of distribution of the questionnaire should have been during the middle of their clinical rounds but that was not feasible as reaching students in their clinical rounds in the hospitals was so difficult. Acknowledgement The project was supervised by Dr. Manal Ibrahim Hanafi, Department of Family and Community Medicine, College of Medicine, Taibah University, Al Madinah Al Munawarah, Saudi Arabia. I appreciate Dr. Salman Yousuf Guraya, Department of Surgery for the scientific review of the manuscript.
Conclusions The predominant forms of stressors which were found among female medical students were social, teaching and learning, interpersonal and group activities related 117 J T U Med Sc 2010; 5(2)
Prevalence of stressors among female medical students
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119 J T U Med Sc 2010; 5(2)
Prevalence of Stressors among Female Medical Students Taibah University Kholoud Abdulrahman Habeeb Final Year Medical Student, College of Medicine, Taibah University Al Madinah Al Munawarah Kingdom of Saudi Arabia
Abstract
Objectives A stressor is defined as a personal or environmental event that causes stress. Studies have revealed that the stressors affecting medical students’ well-being seem to be related to the medical training, especially academic matters. Present study looks into the prevalence of various stressors among female medical students, Taibah University Al Madinah Al Munawarah Saudi Arabia. Methods A cross sectional survey was conducted for all female medical students. The Medical Students Stressor Questionnaire (MSSQ) was used. The response rate was 89.7% (305/340). Statistical analysis was done using percent, mean, standard deviation, Fisher's Exact test, and Kendall's correlation. Results The mean age of the studied students was 21.4±2.34 years. Their mean score was 3.9±0.73.Nearly half (46.2%) of students had high academic related stress, 50.2% had moderate interpersonal stress, 52.8% had moderate teaching and learning related stress. Nearly two thirds (59.7%) had moderate social related stress, 40.7% had moderate desire related stress and 54.1 had moderate group activity related stress. There were correlation between students score and academic (r=-0.120, p=0.036), interpersonal stress (r=-0.100, p=0.027), desire related stress (r=-0.116, p=0.011) and group activity related stress (r=-0.171, p=0.000). Conclusion The predominant forms of stressors which were found among female medical students were social, teaching and learning, interpersonal and group activities related stressors. All forms of stressors became more obvious in clinical years. Stressors were negatively correlated to students' score. Key Words: Stressors, Medical, Students, MSSQ. Journal of Taibah University Medical Sciences 2010; 5 (2): 110 - 119
Correspondence to: Kholoud Abdulrahman Habeeb Fifth year medical student, Medical College, Taibah University
30001, Al Madinah Al Munawarah, Kingdom of Saudi Arabia +966 48460008 +966 48461407 [email protected] 110
Kholoud Abdulrahman Habeeb
Introduction
Students Stressor Questionnaire (MSSQ) was used. The purpose, of the study was explained to the respondents and a verbal informed consent was obtained. Ethics Review Committee reviewed and approved the proposal. The MSSQ grouped stressors into six domains: Academic related stressors (ARS), Intrapersonal and interpersonal related stressors (IRS), Teaching and learningrelated stressors (TLRS), Social related stressors (SRS), Drive and desire related stressors (DRS) and Group activities related stressors (GARS)16. Mild score denoting that it does not cause any stress. Even if it does, it just causes mild stress. Moderate score indicates that it reasonably causes stress. However it can be managed well. High score indicates that it causes a lot of stress. The emotions seem to be disturbed by it. The daily activities are mildly compromised due to it. Sever score indicates that it severely causes stress. It disturbs emotions badly. The daily activities are compromised due to it. Data about the age in years, score gained previous year, current university year, and marital status was obtained.
S
tress is emotional disturbances or changes caused by stressors. Stress is defined as the body's nonspecific response or reaction to demands made on it, or to disturbing events in the environment1,2. It is not just a stimulus or a response but it is a process by which we perceive and cope with environmental threats and challenges3. Personal and environmental events that cause stress are known as stressors4,5. Linn & Zeppa stated that some stress in medical school training is needed for learning. Stress which promotes and facilitates learning is called ‘favourable stress’ and stress which inhibits and suppresses learning is called ‘unfavourable stress’6. The same stressors may be perceived differently by different medical students, depending on their cultural background, personal traits, experience and coping skills6. Tertiary education has always been regarded as highly stressful environment to students7,8. Medical training further adds to the already stressful environment. Studies have revealed a high prevalence of stress in medical students, ranging from 30% to 50%712. The alarming facts suggested a situation of elevated psychological pressure on medical students. A small number of medical students suffer from personal problems, but the effect of this on student psychological morbidity and academic success is unclear8,13. Curriculum differences in medical schools may not necessarily cause differences in the overall pattern of stressors (i.e. most of the top stressors are related to academic matters), although frequency (rank) of some stressors may be significantly different14,15. The present study examined prevalence of various stressors among female medical students, Taibah University, Saudi Arabia, in year 2010.
Statistical Analysis Data was entered and analyzed using SPSS version 13.0. Means (± SD) were computed for continuous and proportions for categorical variables. Kendall's Correlation was used to find out the relation between students' score and various stressors. Fisher's Exact test was used, and 95% significance level was chosen.
Results This survey had a response rate of 89.7% (305/340). The mean age of studied students was 21.4±2.34 years. Their mean score was 3.9±0.73. Only 9.2% (28/305) was married. Nearly half of students had ARS (46.2%); 20.6% of them were enrolled in the fifth years. Sever ARS constituted 6.6% and 60.0% of its cases found in fifth year followed by fourth year (30.0%). There was a statistical significant
Materials and Methods A cross sectional survey was conducted for all female medical students. The Medical
111 J T U Med Sc 2010; 5(2)
Prevalence of stressors among female medical students
difference between classes (p=0.000) as demonstrated in Table 1. Half of the studied students had IRS (50.2%); 25.5% of them from second year. Regarding the sever form of IRS, 46.7% was enrolled in the fifth year. There was a statistical significant difference between classes (p=0.014) shown in Table 2. Moderate form of TLRS were encountered among 52.8%; with a significant difference between classes (p=0.027). Sever form formed 3.9%; of which 41.7% were in the fifth year (Table 3). More than half (59.7%) of studied students had moderate SRS; with insignificant statistical difference between classes. Nearly three quarters (72.7%) of second year medical students having it. More than half of sever SRS (55.6) was encountered among fifth year medical students (Table 4). Moderate (40.7%) and mild (40.3%) DRS were the prevalent one; with a statistical
significant difference between classes (p=0.010). Sever form constituted 2.6% and 75.0% of its cases were in fifth year medical students (Table 5). Moderate GARS was found among 54.1% of students; with a significant difference between classes (p=0.000). Moreover, more than two thirds of sever form of GARS (66.7%) were among fifth year medical students (Table 6). Generally speaking, all stressors were more prevalent among clinical years (3rd, 4th and 5th year) than academic one (1st and 2nd), as shown in Figure 1. There were correlation between students score and academic (r=-0.120, p=0.036), interpersonal stress (r=-0.100, p=0.027), desire related stress (r=-0.116, p=0.011) and group activity related stress (r=-0.171, p=0.000) as outlined in Table 7.
GARS DRS
40.4% 37.9%
SRS
44.3%
TLRS
42.3%
IRS
40.6%
ARS
42.3%
59.6% 62.1% 55.7% Clinical Years
57.7%
Academic Years
59.4% 57.7%
Figure 1: Prevalence of stressors according to year.
112 J T U Med Sc 2010; 5(2)
Kholoud Abdulrahman Habeeb
Table 1: Relation between academic related sressors and grade Mild No
Moderate
High
Severe
Total
%
No
%
No
%
No
%
N
%
1st Year
3
42.9/4.7
35
25.5/54.7
26
18.4/40.6
0
0.0/0.0
64
21.0/100.0
2nd Year
1
14.3/1.5
32
23.4/48.5
32
22.7/48.5
1
5.0/1.5
66
21.6/100.0
3rd Year
0
0.0/0.0
33
24.1/55.0
26
18.4/43.3
1
5.0/1.5
60
19.7/100.0
4th Year
2
28.6/3.4
23
16.8/39.0
28
19.9/47.5
6
30.0/10.2
59
19.3/100.0
5th Year
1
14.3/1.8
14
10.2/25.0
29
20.6/51.8
12
60.0/21.4
56
18.4/100.0
Total
7
100.0/2.3
137
100.0/44.9
141
100.0/46.2
20
100.0/6.6
305
100.0/100.0
P
0.003
Table 2: Relation between interpersonal related stressors and grade Mild
Moderate
High
Severe
Total
N
%
N
%
N
%
N
%
N
%
1st Year
22
33.3/34.3
31
20.3/48.4
10
14.1/15.6
1
6.7/1.6
64
21.0/100.0
2nd Year
11
16.7/16.7
39
25.5/59.1
15
21.1/22.7
1
6.7/1.5
66
21.6/100.0
3rd Year
13
19.7/21.7
34
22.2/56.7
10
14.1/16.7
3
20.0/5.0
60
19.7/100.0
4th Year
11
16.7/18.6
27
17.6/45.8
18
25.4/30.5
3
20.0/5.1
59
19.3/100.0
5th Year
9
13.6/16.1
22
14.4/39.3
18
25.4/32.1
7
46.7/12.5
56
18.4/100.0
Total
66
100.0/21.6
153
100.0/50.2
71
100.0/23.3
15
100.0/4.9
305
100.0/100.0
P-value
0.014*
* p-value is significant at level <0.05
113 J T U Med Sc 2010; 5(2)
Kholoud Abdulrahman Habeeb
Table 3: Relation between teaching and learning related stressors and grade Mild
Moderate
High
Severe
Total
N
%
N
%
N
%
N
%
N
%
1st Year
10
30.3/15.6
35
21.7/54.7
18
18.2/28.1
1
8.3/1.6
64
21.0/100.0
2nd Year
5
15.2/7.6
38
23.6/57.6
21
21.2/31.8
2
16.7/3.0
66
21.6/100.0
3rd Year
8
24.2/13.3
40
24.8/66.7
12
12.1/20.0
0
0.0/0.0
60
19.7/100.0
4th
Year
6
18.2/10.2
23
14.3/39.0
26
26.3/44.1
4
33.3/6.8
59
19.3/100.0
5th Year
4
12.1/7.1
25
15.5/44.6
22
22.2/39.3
5
41.7/8.9
56
18.4/100.0
Total
33
100.0/10.8
161
100.0/52.8
99
100.0/32.5
12
100.0/3.9
305
100.0/100.0
P-value
0.027*
* p- value is significant at level <0.05 Table 4: Relation between social related stressors and grade Mild
Moderate
High
Severe
Total
N
%
N
%
N
%
N
%
N
%
1st Year
11
21.2/17.2
39
21.4/60.9
13
21.0/20.3
1
11.1/1.6
64
21.0/100.0
2nd Year
7
13.5/10.6
48
26.4/72.7
10
16.1/15.2
1
11.1/1.5
66
21.6/100.0
3rd Year
13
25.0/21.7
35
19.2/58.3
11
17.7/18.3
1
11.1/1.7
60
19.7/100.0
4th Year
11
21.2/18.6
33
18.1/55.9
14
22.6/23.7
1
11.1/1.7
59
19.3/100.0
5th Year
10
19.2/17.9
27
14.8/48.2
14
22.6/25.0
5
55.6/8.9
56
18.4/100.0
Total
52
100.0/17.0
182
100.0/59.7
60
100.0/20.3
9
100.0/3.0
305
100.0/100.0
P-value
0.192
* p- value is significant at level <0.05
114 J T U Med Sc 2010; 5(2)
Kholoud Abdulrahman Habeeb
Table 5: Relation between drive and desire related stressors and grade Mild
Moderate
High
Severe
Total
N
%
N
%
N
%
N
%
N
%
1st Year
24
19.5/37.5
31
25.0/48.4
9
18.0/14.1
0
0.0/0.0
64
21.0/100.0
2nd Year
37
30.1/56.1
22
17.7/33.3
7
14.0/10.6
0
0.0/0.0
66
21.6/100.0
3rd Year
26
21.1/43.3
26
21.0/43.3
8
16.0/13.3
0
0.0/0.0
60
19.7/100.0
4th Year
19
15.4/32.2
24
19.4/40.7
14
28.0/23.7
2
25.0/3.2
59
19.3/100.0
5th Year
17
13.8/30.4
21
16.9/37.5
12
24.0/21.4
6
75.0/10.7
56
18.4/100.0
Total
123
100.0/40.3
124
100.0/40.7
50
100.0/16.4
8
100.0/2.6
305
100.0/100.0
Pvalue
0.010*
* p- value is significant at level <0.05 Table 6: Relation between group activities related stressors and grade Mild
Moderate
High
Severe
Total
N
%
N
%
N
%
N
%
N
%
1st Year
16
35.6/25.0
37
22.4/57.8
11
14.3/17.2
0
0.0/0.0
64
21.0/100.0
2nd Year
9
20.0/13.6
43
26.1/65.2
13
16.9/19.7
1
5.6/1.5
66
21.6/100.0
3rd Year
15
33.3/25.0
28
17.0/46.7
17
22.1/28.3
0
0.0/0.0
60
19.7/100.0
4th Year
3
6.7/5.1
34
20.6/57.6
17
22.1/28.8
5
27.8/8.5
59
19.3/100.0
5th Year
2
4.4/3.6
23
13.9/41.1
19
24.7/33.9
12
66.7/21.4
56
18.4/100.0
Total
45
100.0/14.8
165
100.0/54.1
77
100.0/25.2
18
100.0/5.9
305
100.0/100.0
P-value
0.000*
* p- value is significant at level <0.05
115 J T U Med Sc 2010; 5(2)
Prevalence of stressors among female medical students
Table 7: Correlation between students score and various stressors Correlation Coefficient -Academic related stressor -0.120* -Interpersonal related stressor -0.100* -Teaching and learning related stressor -0.070 - Social related stressor 0.004 - Derive and desire related stressor -0.116* - Group related stressor -0.171** *Correlation is significant at the 0.05 level (two tailed). ** Correlation is significant at the 0.01 level (two tailed).
Discussion
Significance 0.036 0.027 0.128 0.938 0.011 0.000
Half of studied students (50%) had IRS. Interpersonal stressors generally relate to relationships between individuals including as verbal, physical and emotional abuse caused by other persons, and conflict with personnel, teachers, colleagues, and staff16. More than half of studied students (52%) had moderate form of TLRS. A high score in this domain indicates that teaching and learning events are the main sources of stress. Consequently, it indicates that teaching and learning activities in the institution are unfriendly to students. This requires looking at components of teaching and learning process to determine the causes of stress on the students16. Nearly two thirds (59%) had Social Related Stressors referred to any form of community and societal relationships that cause stress. It generally relates to leisure time with family and friend, working with the public, private time for own self, working interruption by others, and facing patients’ problems. A high score in this domain indicates that societal and community events are the main sources of stress. This indirectly indicates that students have difficulty spending their time in social and community activities. Drive and desire related stressors refer to any form of internal or external forces that influence one’s attitude, emotion, thought and behavior which subsequently cause stress. It generally relates to unwillingness to study medicine due to various reasons such as not being one’s choice to study it, wrongly choosing the course, being demotivated after knowing the reality of medicine, parental wish to study medicine, and following friends to study medicine16.
Stress is defined as the body's nonspecific response or reaction to demands made on it, or to disturbing events in the environment1, 2. Tertiary education has always been regarded as highly stressful environment to students7, 8. Medical training further adds to the already stressful environment. This study shows that the prevalence of stressors ranged from 37.9-62.1%; which were higher than other performed studies (30-50%)7-12. The same stressors may be perceived differently by different medical students, depending on their cultural background, personal traits, experience and coping skills13. This alarming fact suggests a situation of elevated psychological pressure on female medical students. Academic related stressors refer to any scholastic, university, college, educational or student events that cause stress on students. These include examination systems, assessment methods, grading methods, academic schedule, student activities related to academic events such as getting poor marks in examinations, high-self expectation to do well in studies, large amount of content to be studied, having difficulty to understand content, lack of time to do revision, learning context full of competition, and having difficulty to answer questions given by teachers. This study shows that 46.2% had high ARS. A high score in this domain indicates that academic matters are the main sources of stress. Many studies have reported that the major stressors of medical students were academic related14, 15.
116 J T U Med Sc 2010; 5(2)
Kholoud Abdulrahman Habeeb
Fortunately, this domain had the lowest prevalence (40.7% of moderate form). Group activities related stressors refer to any group events and interactions that cause stress. It generally relates to participation in group discussions, group presentations and others expectations to do well. More than half (54.1%) of students had moderate form of GARS. According to the multicenter study mentioned above, those who perceived it as causing moderate stress have 2 times higher risk to develop distress compared to those who perceived it as causing mild to moderate stress16. Chronic exposure to stressful conditions exerts negative effects on emotional, mental and physical well-being of students. Numerous studies have revealed that persistent stressful conditions were associated with mental and physical health problems in medical students at various stages of their training7, 21. Studies have reported an association of excessive stress level with lowered medical students’ selfesteem6, 17, anxiety and depression18, 19, difficulties in solving interpersonal conflicts20, sleeping disorders21, 22, increased alcohol and drug consumption23-25, cynicism, decreased attention, reduced concentration and academic dishonesty13. It is also associated with inhibition of students’ academic achievement and personal growth development6. Excessive stress was also linked with medical student suicide26. As a result, medical students may feel inadequate and unsatisfied with their career as a medical practitioner in the future7, 8, 27. Long-term exposure to stress can lead to serious health problems. It can predispose to hypertension, diabetes mellitus, obesity, skin disorders, impairment of immune system, infertility, anxiety, depression, digestive problems, etc. Body response to stress varies according to individual predisposition28, 29.
stressors. All forms of stressors became more obvious in clinical years. Stressors were negatively correlated to students' score. Recommendations Planning of an intervention stressors prevention program is needed to be implemented for all students to prevent possible physical disorders resulting from stressors. Continuous supervision of students by the university' academic supervisor is needed to detect any abnormality that could be attributed to stressors. Creation of a student commeasure affair; with an active role that will represent the students with all their problems and also will plan for student social activities are mandatory. Strengthening the bonds and trust between the students and staff are needed to dissolve any barriers and minimize the stressful environment that may be found in the faculty environment. Further researches are needed to study in depth precipitating factors for each type of stressors. Study Limitations Inclusion of male students to compare them with females was supposed to be done but that was not feasible due to various logistics, communication and personnel issues. Timing of distribution of the questionnaire should have been during the middle of their clinical rounds but that was not feasible as reaching students in their clinical rounds in the hospitals was so difficult. Acknowledgement The project was supervised by Dr. Manal Ibrahim Hanafi, Department of Family and Community Medicine, College of Medicine, Taibah University, Al Madinah Al Munawarah, Saudi Arabia. I appreciate Dr. Salman Yousuf Guraya, Department of Surgery for the scientific review of the manuscript.
Conclusions The predominant forms of stressors which were found among female medical students were social, teaching and learning, interpersonal and group activities related 117 J T U Med Sc 2010; 5(2)
Prevalence of stressors among female medical students
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