African Journal of Medical and Health Sciences • Volume 14 • Issue 1 • January-June - 2015 • Pages 1-***
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ISSN 2384-5589
Issue 1 / Volume 14 / Jan-Jun 2015
African Journal of Medical and Health Sciences Official Publication of the Federal Teaching Hospital Abakaliki (FETHA), Nigeria www.ajmhs.org
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ORIGINAL ARTICLE
Prevalence of stress, stressors and coping strategies among medical students in a Nigerian medical school Afiong Oboko Oku, Eme Theodora Owoaje1, Oboko Oboko Oku2, Bassey Monday Ikpeme Departments of Community Medicine and 2Anaesthesia, University of Calabar, Calabar, Cross River State, 1Department of Community Medicine, University College Hospital, Ibadan, Nigeria Address for correspondence: Dr. AO Oku, Department of Community Medicine, University of Calabar, Calabar, Cross River State, Nigeria. E-mail:
[email protected]
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ABSTRACT
Website: http://www.ajmhs.org/ DOI: 10.4103/2384-5589.153384 Quick Response Code:
Introduction: Several international studies suggest that medical school training is associated with high levels of stress. Although stress is peculiar to the medical profession, it is rarely given the desired attention, especially in resource-constrained settings. This study was therefore conducted to determine the prevalence of stress stressors, coping strategies of medical students in the University of Calabar, Nigeria. Materials and Methods: A cross-sectional descriptive survey of 451 medical students was conducted on available classes during the study period. A semi-structured self-administered questionnaire was used to elicit information from respondents. Data were summarized using proportions, and Chi-square test was used to explore associations between categorical variables. Level of significance was set at P < 0.05. Results: Majority (94.2%), of undergraduate medical trainees perceived the training as stressful. The major stressors identified were excessive academic work load (82.3%), inadequate holidays (76.4%), and insufficient time for recreation (76.2%). Feeling depressed, sleeping problems and anxiety were the most common effects of stress reported by the respondents. The coping strategies adopted by the students were mainly positive. Perceived stress was significantly associated with being in the clinical level of study, residing on campus and a higher monthly allowance (P < 0.05). Conclusion: Majority of the students interviewed perceived their training as stressful. There is, therefore, an urgent need for medical educators to introduce of stress management courses or programs into the curriculum. Key words: Coping strategies, medical students, South-east Nigeria, stress, stressors
INTRODUCTION Stress has been defined as the body’s nonspecific response to demands made upon it, or to disturbing events in the environment, thus it is not just a stimulus or a response, but rather a process by which we perceive and cope with environmental threats and challenges.[1] An optimal level of stress may enhance learning. However, excessive stress has been shown to cause physical and mental health problems, reduced self-esteem, and may affect academic achievement,
personal and professional development. Every individual has a certain number of coping resources, and once these coping resources are challenged or exceeded, stress usually results. A tremendous amount of stress medical students encounters in the course of their training have been attributed to the vastness in the academic curriculum, length of the course and consequent financial burden.[2] Tertiary medical training across the globe has been regarded as being highly stressful. Dahlin et al. rightly
Cite this article as: Oku AO, Owoaje ET, Oku OO, Ikpeme BM. Prevalence of stress, stressors and coping strategies among medical students in a Nigerian medical school. Afr J Med Health Sci 2015;14:29-34.
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Oku, et al.: Prevalence of stress/stressors medical students Nigeria
observed that promoting and nurturing well-being students during medical training is a necessity. The equipping of undergraduates with the skills necessary to recognize personal distress (to determine when they need to seek assistance) and to develop strategies to promote their own well-being is fundamental to promoting professionalism. [3] Medical training has long been recognized globally as involving numerous stressors that can affect the well-being of students. [4] In addition to coping with stressors of everyday life, medical students must deal with stressors specific to medical education which includes; information overload, financial indebtedness, inadequate leisure time, pressures of work, work relationships and career choices.[5] These students also face social, emotional, physical and family problems that may affect their learning ability and academic performance. Consequently, it is commonly observed that medical students and resident doctors experience high rates of psychological morbidity when compared with students in other disciplines.[6-8] Globally, studies have shown reported levels of stress among medical students range anywhere from 25% to 75%.[9,10] Similar studies conducted on medical students in the United states, Malaysia and Saudi Arabia have reported stress levels of 26%, 29.6% and 57% respectively and were related to their academic environment.[2,10,11] Another study conducted in Pakistan revealed that two out of every five respondents reported that work/study at medical school affected their personal health and wellbeing. This stress had led to grave consequences such as depression, substance misuse, poor academic performance, sleep problems, low self-esteem and other stress-related outcomes.[12] Obviously, such distress could have adverse effects on students and their professional development. Other studies have documented that this distress has further contributed to marital discord, poor physical health/self-care[13] and in some cases suicide.[14] Although, several reports have been documented on stress among medical students in developed countries, limited information exists in Nigeria pertaining to this important global phenomenon. [15,16] In view of the current national and international initiatives to improve medical education, it is important that medical educators take into cognizance the causes of student’s distress, potential adverse personal and professional consequences and institutional factors that can positively or negatively influence student’s well-being. This study, therefore, aimed to identify possible stressors, associated consequences and coping strategies adopted to deal with the identified stressors. 30
MATERIALS AND METHODS Study area
The study was carried out among medical students at the College of Medical Sciences, University of Calabar. The university is located in Calabar South Local Government Area of Cross River State. The College of Medicine was established in 1975. It is one of the largest undergraduate medical training institutions in the south-south zone of Nigeria. The institution produces an average of 80 medical doctors annually. In their first year, the students are exposed to premedical sciences, thereafter basic medical sciences in the second and third levels of study. From the fourth to the sixth levels, they are exposed to clinical courses. Students from this institution come from mainly from the southsouth and south-west region of the country. In 2010, the total number of medical students was 917. Study population
Medical students in the University of Calabar. Study design
A Descriptive cross-sectional study. Sample size calculation
The appropriate sample size formula for a single proportion (Kish and Leslie sample size formula) was used to calculate the sample size. The minimum sample size calculated was approximately 451. Eligibility criteria All medical students undergoing training in the University of Calabar at the time of the study were eligible to participate. Exclusion criteria The third and final year students were on vacation at the time the study was conducted and thus were excluded from the study.
Medical students from all levels of study were recruited into the study. However, at the time of the study only four levels of study were available (1, 2, 4 and 5). This was because the third level students had just written their professional examination and was on vacation. Similarly, the final year students had just graduated from the medical school. All medical students who were available at the time the study was conducted were eligible to participate. The class representative of each class was consulted a day before and informed in preparation for the data collection exercise. Immediately after their lectures, a brief explanation of the survey and its instruments were given to the students.
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Thereafter, a self-administered questionnaire was distributed by the investigator and two trained research assistants. The questionnaires were retrieved immediately following completion, and this was repeated for the rest of the classes visited. The students were asked to give their honest responses to each question and were not allowed to discuss with one another while completing the questionnaires. A total of 451 questionnaires were administered, and all were returned. Data management
Data were collected using a semi-structured, selfadministered questionnaire which was divided into sections to elicit information on socio-demographic characteristics, Stressors affecting their well-being divided into 6 domains to include; (academic, accommodation, relationships, transportation, utilities and other), consequences of stress and coping mechanisms employed by the medical students. Questionnaires were inspected daily so as to detect errors, and omissions to ensure that it was properly filled. Thereafter, the data were entered into the computer for statistical analysis using IBM Statistical Package for Social Scientists SPSS for windows version 19.0. Frequency, proportions, means and standard deviation were generated to summarize variables. Chi-square test was used to test associations between categorical variables. Ethical consideration
Ethical approval was sought for and obtained from the University Of Calabar Teaching Hospital Ethical Review Committee before data collection commenced. Careful explanation of the purpose, content and implication was made known to the participants. Informed consent done in writing was obtained from each respondent after careful explanation of study objectives had been made. Students who were stressed were offered counseling services.
RESULTS
Figure 1: Perceived stress ratings of respondents
Table 1: Socio-demographic characteristics of respondents (n = 451) Variable Age (years) ≤19 20-24 25-29 ≥30 Mean±SD Gender Male Female Marital status Single Married Residence On campus Off campus Level of study Year 1 Year 2 Year 4 Year 5 Monthly allowance ≤N9999 N10,000-19,999 N20,000-29,999 N30,000-39,999 ≥N40,000 Nil response Median (range)
Frequency n (%) 80 (17.7) 200 (62.1) 134 (29.7) 37 (8.2) 23.44±4.38 288 (63.8) 163 (36.2) 437 (96.9) 14 (3.1) 233 (51.7) 218 (48.3) 82 (18.2) 75 (16.6) 184 (40.8) 110 (24.4) 125 (27.7) 167 (37.0) 75 (16.6) 26 (5.8) 24 (5.3) 34 (7.3) N12,000 (500-100,000)
Four hundred and fifty-one, undergraduate medical trainees from the University of Calabar were studied. The mean age of respondents was 23.4 ± 2.44 years. Majority, 200 (62.1%) were in the age group 20-24 years, male 288 (63.8%) and were currently single 437 (96.9%). More than half (51.7%) resided on campus and in their clinical levels 294 (65.8%). More students, 167 (37%) had a monthly allowance of N10,000
