Psychosocial correlates of perceived stress among undergraduate medical students in Nigeria

Objectives To assess the prevalence and factors associated with perceived stress among medical students. Methods A cross-sectional study of students (n=623) selected across eight medical schools in Nigeria. A structured questionnaire obtained socio-demographic characteristics, alcohol use (Alcohol Use Disorders Identification Test), other psychoactive drug use (Drug Abuse Screening Test), anxiety/depression symptoms (Hospital Anxiety Depression Scale) and stress (Perceived Medical School Stress Scale). We performed bivariate analysis using the chi-squared test, t-test and one-way ANOVA, with multiple regression analysis for multivariate testing in analysing the data. Results Most students reported experiencing medical school stress. Female participants were more likely to perceive medical school as competitive (t(621)=1.17, p=0.003), less likely to see medical school as a threat (t(621)=-2.70, p=0.01) or worry about finances (t(621)=-4.80, p=0.001). Nearly a quarter; 21.3% (n=133) and 28.6% (n=178) reported depression and anxiety symptoms respectively. Approximately 4.2% (n=26) were dependent on alcohol, while 14.1% (n=88) had 'low-risk use' for other psychoactive substances. In the multiple regression model, lack of finance (B=2.881, p=0.001), weak adherence to religious faith (B=2.376, p=0.001), anxiety symptoms (B=-2.231, p=0.002), problematic alcohol use (B=5.196, p=0.001) and choice of study influenced by parents (B=-3.105, p=0.001) were predictors of greater perceived stress. Conclusions Medical students in Nigeria report high levels of stress. Incorporating stress reduction strategies in the medical curriculum, and the input of students in providing feedback regarding the methods and styles of undergraduate medical education is required.