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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 5  |  Issue : 2  |  Page : 53-60

Association between anxiety and sociodemographic characteristics among medical students in Al-Imam Mohammad Ibn Saud Islamic University, Saudi Arabia


Department of Family Medicine, College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University, Al-Nada, Riyadh, Saudi Arabia

Date of Submission12-Dec-2019
Date of Acceptance29-Feb-2020
Date of Web Publication07-Aug-2020

Correspondence Address:
Dr. Fahad Abdullah Alateeq
College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University, Al-Nada, Riyadh 13317-4233
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijas.ijas_33_19

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  Abstract 


Background: Anxiety is a common medical issue in Saudi Arabia, particularly among medical students. Therefore, the present study aimed to assess the association between anxiety and sociodemographic characteristics among medical students in Saudi Arabia.
Materials and Methods: In this descriptive cross-sectional study, 350 questionnaires were distributed among medical students to investigate the presence of anxiety disorders among them and the associated demographic factors. The study included medical students of different education years at the Faculty of Medicine, Al-Imam Mohammad Ibn Saud Islamic University. A questionnaire formed of 35 questions was distributed electronically among the students by the help of the leader of each educational year. The level of anxiety of each student was determined according to the score of questionnaire answers and the Beck Anxiety Inventory; where the score of 0–21 = no or low anxiety, score of 22–35 = moderate anxiety, score of 36 and above = severe or potentially concerning levels of anxiety.
Results: Three hundred and sixteen medical students completed the questionnaire with a response rate 90%. Anxiety was identified in 201/316 (63.6%) students; 98/201 (48.7%) students were with moderate anxiety, and 103/201 (51.3%) with severe anxiety. Out of the 236 males, 136/236 (57.6%) were found to have anxiety, whereas, of the 80 females, 65/80 (81.3%) were found to have anxiety. About 51.3% of the females were found to have severe anxiety compared to only 26.3% of the males.
Conclusion: Anxiety is a common problem among medical students of Al-Imam Mohammad Ibn Saud Islamic University, Saudi Arabia with more prevalence among female medical students compared to males. Furthermore, there was a significant association between satisfaction to study medicine and decreased anxiety development. However, there was no significant association between anxiety and the other studied sociodemographic factors.

Keywords: Anxiety, medical students, Saudi Arabia


How to cite this article:
Alateeq FA. Association between anxiety and sociodemographic characteristics among medical students in Al-Imam Mohammad Ibn Saud Islamic University, Saudi Arabia. Imam J Appl Sci 2020;5:53-60

How to cite this URL:
Alateeq FA. Association between anxiety and sociodemographic characteristics among medical students in Al-Imam Mohammad Ibn Saud Islamic University, Saudi Arabia. Imam J Appl Sci [serial online] 2020 [cited 2020 Nov 29];5:53-60. Available from: https://www.e-ijas.org/text.asp?2020/5/2/53/291583




  Introduction Top


Anxiety is a condition of boost caution resulting in elevated sensory sensitivity related to uncertainty.[1],[2] Limited control over worrisome thoughts, biased alerts, and sharing major attentiveness on negative stimuli, represent the major features of anxiety.[3],[4] Analytically, the overgeneralization of fear of meaningless stimuli or states is a problem to everyday life and typical of posttraumatic stress disorder and other anxiety complaints.[5]

Anxiety, although as prevalent and probably as enervating as depression, has gained less awareness, and is often-time undetected and undertreated in the general population. Anxiety among medical students deserves the utmost heed because of its considerable effects.[6] Academic performance, stress to do well, and postgraduation plans, poor lifestyles, financial limitations, shortage of support facilities for stress management, and lack of physical and entertainment facilities are the most common causes of anxiety among those students.[7] The most common symptoms of anxiety include nervousness, scaring, flushing of the face and feeling hot, maldigestion, impatience, faintness or lightheadedness, difficult breathing, feeling of fear, tachycardia, tingling or numbness of fingers, hot or cold sweats, feeling of chocking, fear of losing control, inability to relax, unsteadiness, and fear of worst happening.[8]

About one in three medical students worldwide have anxiety - a prevalence rate that is considerably higher than the general population. Furthermore, medical students rarely seek professional psychiatric help because of shame and taboo related to psychological disorders.[9]

Anxiety has adverse effects on the students either on their physical health, mental health, or their academic achievements where it hinders their success. They always suffer from stress, exhaustion, and burnout, lack of creativity and poor communication and interaction either with the patients or with their colleagues. This will have adverse implications on the future physicians and the patients.[10] In addition, these students may have depression, social isolation, or other mental health disorders, substance abuse, difficult sleeping, gastrointestinal tract problems, poor quality of life, and tendency to suicide.[4],[11]

Anxiety is the most common psychological disorder as reported by the European Union, where it affects about 60 million of the population.[12] Its prevalence in the Middle East and North Africa represents 7.7%.[13]

A meta-analysis conducted by Quek et al., to assess the Global Prevalence of Anxiety among Medical Students and its related risk factors. It included 69 studies and 40,384 medical students. Its results showed that the global prevalence of anxiety among the medical students is 33.8%, with the highest prevalence among medical students from Asia and The Middle East. In addition, its results showed that female medical students had a higher prevalence of anxiety representing 38.0% compared to male students representing 27.6%.[6] A systemic review conducted by Alaa Mohammed to assess the prevalence of anxiety among college and school students in Saudi Arabia. This review involved 19 studies from 2007 to 2018. Its results showed that the prevalence of anxiety among the students ranges between 34.9% and 65% and that it was more common among the female medical students compared to males.[14]

A study conducted by Inam[15] to assess the prevalence of anxiety and depression among the students of the College of Medicine, Qassim University, which was 66% among females, while it was 44.4% among males, with the highest percentages among the students of the 1st year. Asiri et al. conducted a study to assess the prevalence of anxiety among the medical students in Najran University that showed 71% of students have anxiety.[16]

The objectives of this study were to detect the prevalence of anxiety among medical students of Al-Imam Mohammad Ibn Saud Islamic University, and also to assess the association between anxiety and the sociodemographic characteristics.


  Materials and Methods Top


This is a descriptive cross-sectional study conducted among the medical students of the Faculty of Medicine, Al-Imam Mohammad Ibn Saud Islamic University. Three hundred and fifty questionnaires were distributed among them to detect the prevalence of anxiety disorders and its association to the demographic factors. All medical students from 1st year to 5th year in addition to intern students and preparatory year students were included in this study, where the involved students were selected randomly. A purposeful questionnaire was designed and used for obtaining the necessary data. The questionnaire was filled online through Google forms. It was distributed electronically with the help of the leader of each year. This questionnaire is formed of 35 questions divided into two parts; the first part includes 14 questions about the demographic data of the student including (age, sex, marital status, college grade level, grade point average [GPA]) and the second part includes 21 questions about the common symptoms of anxiety that the students had during the last month. The score and the level of anxiety of each student have been determined according to the Beck Anxiety Inventory.[8],[17] Each one of the 21 questions related to the symptoms of anxiety has one of four answers; not at all = 0, mildly, but it did not bother me much = 1, moderately – it was not pleasant at times = 2, severely – it bothered me a lot = 3. The total score is calculated by finding the sum of the 21 items. Score of 0–21 = no or low anxiety, score of 22–35 = moderate anxiety, score of 36 and above = severe or potentially concerning levels of anxiety.

The collected data were coded and analyzed using SPSS program (SPSS 2016 Inc. Chicago, Illinois, USA).

Approval for this research was obtained from Institutional Review Board of Al-Imam Mohammad Ibn Saud; its number is 64-2019.


  Results Top


Three hundred and fifty questionnaires were distributed among the medical students through the leader of each students' year. Three hundred and sixteen complete questionnaires were returned with a response rate of 90%. The involved students were selected randomly from all the years.

The age of the respondents was ranging from 17 to 30 years, with a mean age of 20.5 years. Out of 316 participants, 236/316 (75%) were male, and 80/316 (25%) were female, as indicated in [Table 1]. Out of the 316 studied medical students, anxiety was identified in 201/316 (63.6%) students, 98/201 (48.7%) students were with moderate anxiety and 103/201 (51.3%) with severe anxiety.
Table 1: Distribution of the study population by age and gender

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[Table 2] and [Figure 1], [Figure 2] summarize the distribution of anxiety status by gender, age, education level, and GPA. Out of the 236 males, 136/236 (57.6%) identified with anxiety, hence, of the 80 females, 65/80 (81.3%) were found with anxiety. About 51.3% of the females were found with severe anxiety compared to only 26.3% of the males, as shown in [Figure 1].
Table 2: Anxiety status by gender, age, education level, and grade point average

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Figure 1: Anxiety status by gender, age

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Figure 2: Anxiety status by education year and grade point average

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There was a significant association between anxiety and gender where P = 0.00, as shown in [Table 2].

With regard to overall anxiety in each age group, the highest percentages of anxiety were observed in age 23 years followed by 20, 19, 21, and 24 years, constituting 22/30 (73.3%), 48/68 (70.6%), 25/39 (64%), 38/66 (57.6%), 19/33 (57.6%), respectively. Regardless of the number in each age group, the highest percentages of severe anxiety were seen among age ≤18 years, followed by 22 years and 20 years old representing 43.7%, 42.8%, and 39.7% in this order. High percentages of moderate anxiety were experienced by 23 years, followed by 25 years, and 19 years, constituting 50%, 40%, and 38.5%, respectively, as shown in [Figure 1]. However, no significant association was found between anxiety level and age; P = 0.762 and 0.651 as resulted from Pearson Chi-square test and Likelihood ratio test, respectively. The highest percentages of moderate anxiety were observed among 3rd year students followed by 5th years, preparatory year, and internship, constituting 47.8%, 33.3%, 29%, and 28%, respectively. The highest percentages of severe anxiety were observed among 1st year students followed by 2nd year, and 4th year, representing 47.4%, 38%, and 30.4%, correspondingly, as shown in [Figure 2]. There was no significant association between education year and anxiety level. On the other hand, the highest percentages of moderate anxiety were found among students with excellent GPA, followed by very good, good and acceptable GPA, representing 35.6%, 35%, 30.5%, and 21.3%, in this order. There was no significant association between GPA and anxiety level, whereas, the highest percentages of severe anxiety were noticed among students with acceptable GPA followed by good, very good, very good and excellent, constituting, 42.6%, 34.3%, 31%, and 28.8%, respectively, indicating reverse association as shown in [Figure 2] and [Table 2].

With regard to the economic status, 121/205 (59%), 77/108 (71.3%), and 3/3 (100%) of individuals with anxiety have indicated good, moderate, and poor economic status, in this order, as indicated in [Table 3]. About 181/289 (62.6%) of the students with anxiety have claimed prior preference to study medicine, whereas, 20/27 (74%) with anxiety have no prior preference to study medicine, as indicated in [Table 3] and [Figure 3]. Moreover, 95/173 (55%) of those still satisfied in studying medicine were found with anxiety with significant association (P = 0.01, 0.008). About 64/88 (72.7%) with anxiety stated as “not sure” about their satisfaction. Moreover, 42/55 (76.4%) with anxiety stated that they are not satisfied with studying medicine, as summerized in [Table 3] and [Figure 3].
Table 3: Anxiety status by economic status and studying medicine

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Figure 3: Anxiety status by economic status and studying medicine

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  Discussion Top


Although generalized anxiety is a common public condition, comorbidity associated anxiety is highly prevalent (up to 90%) all over the globe.[18] Most of the studies reporting anxiety related to comorbidities rather than social-related anxiety.[19],[20],[21],[22],[23]

The present study reported an overall prevalence of anxiety 63.6% (48.7% moderate anxiety and 51.3% severe anxiety) among the studied medical students. A Saudi study assessed the prevalence of depression among male medical students and interns, exposed a depression prevalence of was 53.8%.[24] International studies reported diverse anxiety prevalence rates, some of which similar to the findings of the current study. In a study to evaluate the depression, stress, and anxiety among final year medical students reported an overall, 57.6% of the students experienced moderate to tremendously severe depression, 74% of the students reported moderate to enormously severe anxiety, and 57.7% students had moderate to tremendously severe stress.[25] In a recent meta-analysis, the prevalence of depression ranged from 13.10% to 76.21% with a mean of 32.74%, and the prevalence of anxiety ranged from 8.54% to 88.30% with a mean of 27.22%.[26]

The present study found that anxiety more common among females (81.3%) compared to males (51.3%). Such findings were reported by several previous studies.[27],[28] Anxiety was found fluctuating in different age groups, and since the study population exhibiting a close age range, there was no apparent variety that can be statistically computed.

In the present study, there was no significant association between education year and anxiety level; however, the highest percentages of severe anxiety were observed among 1st year students followed by 2nd year, and 4th year, hence, moderate experienced by 3rd year students followed by 5th years. There is no apparent factor for these findings except the intensity of the running courses or subjects. Moreover, the results of this study evidenced that anxiety has a reverse proportion with the student's GPA, specifically in terms of anxiety severity. There was no significant association between GPA and anxiety level but students with a high GPA have lower anxiety than those having a subordinate GPA. Such findings were previously reported, where medical students with a low GPA have more tendency to elevate spasm of anxiety than those with better GPA achievement.[29]

In the current study, the number of anxiety cases are more in those with good economic status compared to those with poor economic status; however, the results are nonsignificant (P = 0.224). Such findings don not agree with other studies that reported the association between low socioeconomic status and generalized anxiety disorder.[30],[31]

Worth mentioning, there was no significant association between prior preference to study medicine and level of anxiety (P = 0.695). Moreover, medical students who are satisfied in their current studies of medicine are experiencing less anxiety with a significant association between satisfaction of studying medicine and decreased anxiety development (P = 0.10 and 0.008).

The high prevalence of anxiety among medical students generally has many predisposing factors including over examinations and lack of time for studying, where the students may study all night before the exam. Heavy course load, pressure of passing the examinations and getting high grades, pressure of achieving family expectations, fear of stepping into the real practical life, stress of taking the responsibility for the patient life and well-being, pressure of choosing the appropriate specialty and the postgraduation plans, gaps between studying and practical life, pressure of United States Medical Licensing Examination and competition on different specialties and residency other factors that induce anxiety for medical students.[25],[32] Furthermore, large periods of time required for studying medicine hinder most of the students from practicing extracurricular activities or practicing their hobbies that puts them in more stress however the root cause of anxiety is present in the curricula, either due to large amounts or unnecessary old details.[9]

Regarding the current status of Al-Imam Mohammad Ibn Saud Islamic University College of Medicine, student's selection is done through the following steps:

  1. Application is submitted through the unified portal for admission within specific and officially announced period by the university
  2. Applicants for the health track would be accepted according to the following requirements:


    1. The secondary school general score must be 90% and above, weighing 30% of the total score
    2. The achievement test score must be 70 and above, and weighing 40% of the total score
    3. The ability test score must be 70 and above, and weighing 20% of the total
    4. The STEP examination score must be 50% and above, and weighing 10% of the total
    5. The applicant must have been graduated from high school in the year of application date or previous academic year
    6. Passing an interview of the College of Medicine.


The College of Medicine is adopting SPICES approach. The curriculum of the four phases of the medical program as follows:

  1. Preparatory year: (1-year)
  2. Preclerkship phase: foundation of basic and clinical sciences (3 years)
  3. Clerkship phase: (2 years)
  4. Internship: hospital-based rotation (1-year).


Al-Imam College of Medicine does not apply pass-fail grading but apply grading system method where students are classified as A+, A, B+, B, C+, C, D+, D, and F and each grade contains a range of percentage or marks. All faculties including affiliated tutors have to go through training programs such as induction courses and continuous faculty and professional development programs to ensure their quality to design the instruction.

Here, we will discuss some practical solutions to this psychological problem that affects our medical students. Regular psychological evaluation and checkup to the medical students by the mental health professionals in counseling centers in the college for early detection of any psychological problem and early management of it.[33]

Preparation of educational programs and workshops for medical students. These programs should include information about the anxiety disorders, their symptoms and complications. Also, they should include methods that help students deal with the stressors and manage their time. Those workshops and meeting of the students with counselors were associated with decreased anxiety among medical students in India.[25],[34] Encouraging the students to study regularly to be prepared the examinations and not be overloaded at a short time before them. Avoiding assigning the students with excessive assignments.[14]

Application of workshops for the staff of medical colleges for their education about the anxiety disorders that affect students and how to detect the affected students and how to deal with them.

Application of resilience and mindfulness curriculum; mindfulness-based stress reduction programs, which were found to reduce the psychological stress among medical students.[35]

Reduction of curricular time, reduction of the amount of unnecessary detailed Curricula by specialized committees, development of theme-based learning communities, and application of problem based learning programs. Those approaches were found to be associated with decreased level of anxiety among the students.[9]

Change to pass/fail grading instead of numerical grading; a study conducted by Reed DA, to assess the relationship of pass/fail grading with well-being among preclinical medical students. Its results showed that students of colleges using grading system have higher levels of stress compared to those in colleges using pass/fail system.[36]

The organization of social events for the medical students throughout the year which will improve the levels of students' engagement, strengthen their relationships with their professors and colleagues.

Application of active learning strategies as flipped classroom, team-based learning methods also was found to improve the students' performance and reduce their anxiety level.[9]


  Conclusion Top


Anxiety is a common problem among medical students of Al-Imam Mohammad Ibn Saud Islamic University, Saudi Arabia, with more prevalence among female medical students compared to males. In addition, there was significant association between satisfaction to study medicine and decreased anxiety development. However, there was no significant association between anxiety and the other studied sociodemographic factors. Hence, further research is needed to identify the entire causes of anxiety among Saudi medical students. Furthermore, we need to apply different measures to overcome this health problem and conduct research to assess the success of these measures.

The limitations of this study that it was confined to a single college, so more studies are required to involve more colleges. However, choosing only one college helped us to know the localized causes of this health problem.

Acknowledgment

The author would like to thank medical students at the Faculty of Medicine, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia. Furthermore, he would like to thank Dr. Hassan Darami, MD, Head of Medical Education Department and Director of Assessment Unit for his help regarding the education status in the college.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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