Levels and predictors of stress among medical students in Alexandria

In recent years there has been a growing appreciation of the issues of quality of life and stresses involved in medical training, as this may affect their learning and academic performance. However, such studies are lacking in medical schools of Egypt. Therefore, we carried out this study to assess the prevalence of psychological morbidity, sources and severity of stress among undergraduate medical students in Alexandria Faculty of Medicine. A cross-sectional, questionnaire-based survey was carried out among the undergraduate medical students at Alexandria Faculty of Medicine during the academic year 2006/2007. An anonymous self-administered questionnaire was used to collect personal and socio-demographic data. The psychological morbidity was assessed using the 30-item General Health Questionnaire [GHQ-30]. A 25-item questionnaire was used to assess sources of stress and their severity. Students from all academic years were represented in the study sample. A total of 379 students were included in the study. Both prevalence and levels of stress were considerably high. The overall estimated prevalence of stress was 85.2%, while the overall mean score on the GHQ was 16.4 +/- 7.0. The high levels of distress were experienced by medical students in all academic years, being highest among third year students. There were significant differences in prevalence and mean scores of stress between both sexes, being higher in female students as compared to males. Principal stressors were related to academic pressures and psycho-social/quality of life issues rather than to personal problems. Variables proved to be significantly associated with stress among medical students, included: being a female [OR =2.137]; concerns over choice of the medical career [OR=2.423]; dissatisfaction with current teaching methods in equipping students with essential competencies/possibility of future incompetence [OR=2. 837]: sense of insecurity concerning professional future/feeling that medical profession has failed [OR=2.957]; curriculum overload [OR= 1.971]; nature and subjectivity/unfairness of examinations [OR= 2.208 and 2.485 respectively]; inability of examinations to assess students' real skills [OR=3. 745]; lack of time for relaxation/relief [OR=4.732]; effect on private life with lack of time for recreation, practicing any personal hobbies [OR =2.752], social relationships [OR=2.462], or sports [OR=1.815]; fear of dealing with patients [OR=2.533]; inability to deal with death or suffering [OR=2.214]; and lack of supportive home atmosphere/environment [OR =2.822]. The high level of psychological morbidity warrants need for interventions like social and psychological support to improve the quality of Iife for our medical students. Student advisors and counselors may train students about stress management. There is also need to bring about academic changes concerning the content of curricula, quality of teaching and evaluation system. More leisure time activities, better interaction with the academic staff and proper guidance, and advisory services at medical schools could do a lot to reduce the stress