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Stress, Anxiety, and Depression Among Nursing Students: Basis For An Intervention Program

Volume 6 - Issue 2, February 2023 Edition
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Vanessa N. Fernandez, Marichu P. Diendo
Anxiety, depression, intervention program, nursing students, stress
Nursing school is challenging and overwhelming. It has been well-documented that nursing students worldwide experience stress, anxiety, and depression throughout their formal education and clinical training. The main objectives of the present study were to determine the levels of stress, anxiety, and depression among nursing students in General Santos Doctors' Medical School Foundation, Inc. and to develop an intervention program based on the results of the study. A descriptive survey research design was conducted among a randomized sample of 163 nursing students in General Santos Doctors' Medical School Foundation, Inc. from March to April 2021. Data collection was performed using the Depression Anxiety Stress Scale (DASS-42). Out of 163 identified randomized samples, 146 nursing students participated in the study; most of them were within the 17–20 year old age bracket and in their first year. Furthermore, the majority of the respondents experienced stress, anxiety, and depression, which ranged from mild to extremely severe levels. Results also showed that among the three psychological health issues, anxiety was the most prevalent. The Counselor CARES (Caring About Restoring Students' Well-being) intervention program, a CBT-based intervention program, has been developed to address the mental health problems of students, specifically stress, anxiety, and depression.
[1]. Abu Ruz, M. E., Al-Akash, H. Y., & Jarrah, S. (2018). Persistent Anxiety and Depression Affected Academic Achievement and Absenteeism in Nursing Students. The Open Nursing Journal, 12(1), 171–179. https://doi.org/10.2174/1874434601812010171

[2]. Adetunji, A. and Ademuyiwa, J. (2019). Assessing DASS-42 Models among Polytechnic Staff. Open Access Library Journal, 6, 1-9. https://doi.org/10.4236/oalib.1105334

[3]. Admi, H., Moshe-Eilon, Y., Sharon, D., & Mann, M. (2018). Nursing Students’ Stress and Satisfaction in Clinical Practice along Different Stages: A Cross-Sectional Study. Nurse Education Today, 68, 86–92. https://doi.org/10.1016/j.nedt.2018.05.027

[4]. AlKandari, N. (2020). Students Anxiety Experiences in Higher Education Institutions. Anxiety Disorders - The New Achievements. https://www.intechopen.com/chapters/71699

[5]. Amanvermez, Y., Rahmadiana, M., Karyotaki, E., de Wit, L., Ebert, D. D., Kessler, R. C., & Cuijpers, P. (2020). Stress management interventions for college students: A systematic review and meta?analysis. Clinical Psychology: Science and Practice, e12342 DOI:10.1111/cpsp.12342 https://www.researchgate.net/publication/341583041_Stress_management_interventions_for_college_students_A_systematic_review_and_meta-analysis

[6]. American College Health Association (2020). American college health association-National college health assessment III: Undergraduate student reference group executive summary spring 2020. https://www.acha.org/documents/ncha/NCHA III_Spring_2020_Undergraduate_Reference_Group_Executive_Summary.pdf.

[7]. American Psychological Association (2022). Depression. https://www.apa.org/topics/depression

[8]. American Psychological Association (2014). APA Ethics Code Addresses When Obtaining Informed Consent from Research Participants Is Necessary https://www.apa.org/news/press/releases/2014/06/informed-consent/

[9]. Anxiety and Depression Association of America (2021). Facts & Statistics. https://adaa.org/understanding-anxiety/facts-statistics/

[10]. Becker, D. (2022). Depression by Age. https://www.sutterhealth.org/health/mental/depression-by-age

[11]. Benjet C. (2020). Stress Management interventions for college students in the context of the COVID-19 pandemic. Clinical psychology: a publication of the Division of Clinical Psychology of the American Psychological Association, e12353, advance online publication. https://doi.org/10.1111/cpsp.12353

[12]. Bernaras, E., Jaureguizar, J., & Garaigordobil, M. (2019). Child and Adolescent Depression: A Review of Theories, Evaluation Instruments, Prevention Programs, and Treatments. Frontiers in psychology, 10, 543. https://doi.org/10.3389/fpsyg.2019.00543

[13]. Best Colleges (2021). The Top 5 Mental Health Challenges Facing College Students and How to Get Help. https://www.bestcolleges.com/resources/top-5-mental-health-problems-facing-college-students/

[14]. Bhandari, P. (2021). Ethical Considerations in Research Types & Examples. https://www.scribbr.com/methodology/research-ethics/

[15]. Bhargava, D. & Trivedi, H. (2018). A Study of Causes of Stress and Stress Management among Youth. IRA International Journal of Management & Social Sciences. http://www.researchgate.net

[16]. Bhatt, N. V. (2019). What are the psychodynamic and cognitive theories of anxiety? https://www.medscape.com/answers/286227-14519/what-are-the-psychodynamic-and-cognitive-theories-of-anxiety

[17]. Calzon, B. (2022). A Guide to the Methods, Benefits & Problems of the Interpretation of Data. https://www.datapine.com/blog/data-interpretation-methods-benefits-problems/

[18]. Cestari, V., Barbosa, I., Floencio, R., Pessoa, V., & Moreira,T. (2017). Stress in nursing students: study on socio-demographic and academic vulnerabilities. Acta Faul Enferm; 30 (2): 190-6. https://www.researchgate.net/publication/318195659_Stress_in_nursing_students_Study_on_sociodemographic_and_academic_vulnerabilities

[19]. Cheung, T., Wong, S. Y., Wong, K. Y., Law, L. Y., Ng, K., Tong, M. T., Wong, K. Y., Ng, M. Y., & Yip, P. S. (2016). Depression, Anxiety and Symptoms of Stress among Baccalaureate Nursing Students in Hong Kong: A Cross-Sectional Study. International journal of environmental research and public health, 13(8), 779. https://doi.org/10.3390/ijerph13080779

[20]. Costa, C., Briguglio, G., Mondello, S., Teodoro, M., Pollicino, M., Canalella, A., Verduci, F., Italia, S., & Fenga, C. (2021). Perceived Stress in a Gender Perspective: A Survey in a Population of Unemployed Subjects of Southern Italy. Frontiers in Public Health, vol. 9. DOI=10.3389/fpubh.2021.640454. https://www.frontiersin.org/articles/10.3389/fpubh.2021.640454/full

[21]. Das, B. N., Mohandas, A., Saba Syed, S. (2021). Study of stress, anxiety, depression and coping strategies among nursing students in a tertiary care teaching hospital, South India. Int J Community Med Public Health. 8(7):3400-3405. https://dx.doi.org/10.18203/2394-6040.ijcmph20212594

[22]. Davis, C. P. (2021). Medical Definition of Stress. https://www.medicinenet.com/stress/definition.htm

[23]. Ebert, D., Mortier, P., Kaehlke, F., Bruffaerts, R., Baumeister, H., Auerbach, R. P. … WHO WMH?ICS Collaborators. (2019). Barriers of mental health treatment utilization among first year college students: First cross?national results from the WHO World Mental Health Initiative. International Journal of Methods in Psychiatric Research, 28(2), e1882 10.1002/mpr.1782. https://doi.org/10.1002/mpr.1782

[24]. Elyzeed, S. (2018). Stress, Anxiety, and Depression among Baccalaureate Nursing Students. https://www.researchgate.net/publication/331305623_Stress_Anxiety_andDepression_among_Baccalaureate_Nursing_Students

[25]. Fawaz, M. & Samaha, A. (2020). E-learning: Depression, anxiety, and stress symptomatology among Lebanese university students during COVID-19 quarantine. Nursing Forum. https://doi.org/10.1111/nuf.12521

[26]. Florescu, S., Mihaescu Pintia, C., Ciutan, M., Sasu, C., Sfetcu, R., Scintee, S.G., Vladescu, C. (2019). Interventions to reduce stress, anxiety and depression symptoms in teenagers – a systematic review. European Journal of Public Health, Volume 29, Issue Supplement_4 https://doi.org/10.1093/eurpub/ckz186.581

[27]. Gao, W., Ping, S., Liu, X. (2020). Gender differences in depression, anxiety, and stress among college students: A longitudinal study from China. Journal of Affective Disorders, Volume 263, Pages 292-300, ISSN 0165-0327. https://doi.org/10.1016/j.jad.2019.11.121.

[28]. Gautam, M., Tripathi, A., Deshmukh, D., & Gaur, M. (2020). Cognitive Behavioral Therapy for Depression. Indian journal of psychiatry, 62 (Suppl 2), S223–S229. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_772_19

[29]. Glerean, N., Hupli, M., Talman, K., & Haavisto, E. (2017). Young peoples' perceptions of the nursing profession: An integrative review. Nurse education today, 57, 95–102. https://doi.org/10.1016/j.nedt.2017.07.008

[30]. Graham, M. M., Lindo, J., Bryan, V. D., & Weaver, S. (2016). Factors Associated With Stress Among Second Year Student Nurses During Clinical Training in Jamaica. Journal of Professional Nursing, 32(5), 383–391. https://doi.org/10.1016/j.profnurs.2016.01.004

[31]. Graves, B. S., Hall, M. E., Dias-Karch, C., Haischer, M. H., & Apter, C. (2021). Gender differences in perceived stress and coping among college students. PloS one, 16(8), e0255634. https://doi.org/10.1371/journal.pone.0255634

[32]. Guarnotta, E. (2020). How Is Age Related to Anxiety? https://www.goodrx.com/conditions/generalized-anxiety-disorder/how-is-age-related-to-anxiety

[33]. Holland, K. (2020). Everything You Need to Know About Anxiety. https://www.healthline.com/health/anxiety

[34]. Houston, K. (2021). Quantitative data-collection methods. https://www.jotform.com/blog/quantitative-data-collection-methods/

[35]. Jerreholt, J., & Martinez, Z. (2017). Students’ Perspectives on School-related Stress and the Role of the Student Health Services. https://www.diva-portal.org/smash/get/diva2:1071661/FULLTEXT01.pdf

[36]. Koirala, S. & Poudel, A. (2018). Prevalence and factors associated with depression among nursing students. International Journal of Science and Research, 8(5), 51-54. https://www.ijsr.net/archive/v8i5/ART20197170.pdf

[37]. Kumar, P., Pathania, S., Aarti, Isha, Manisha, Bhardwaj, M., & Sharma, M. (2020). Academic Stress among Nursing Students. Nursing & Healthcare International Journal, 4(3): 000227. https://doi.org/10.23880/nhij-16000227

[38]. Labrague, L. J., McEnroe–Petitte, D. M., De Los Santos, J. A. A., & Edet, O. B. (2018). Examining stress perceptions and coping strategies among Saudi nursing students: A systematic review. Nurse Education Today, 65, 192–200. https://doi.org/10.1016/j.nedt.2018.03.012

[39]. Lally, J., Tully, J., & Samaniego, R. (2019). Mental health services in the Philippines. BJPsych international, 16(3), 62–64. https://doi.org/10.1192/bji.2018.34

[40]. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer publishing company.

[41]. Lee, J., Jeong, H. J., & Kim, S. (2021). Stress, Anxiety, and Depression among Undergraduate Students during the COVID-19 Pandemic and their Use of Mental Health Services. Innovative higher education, 1–20. Advance online publication. https://doi.org/10.1007/s10755-021-09552-y

[42]. Lei, X., Liu, C., & Jiang, H. (2021). Mental health of college students and associated factors in Hubei of China. https://doi.org/10.1371/journal.pone.0254183

[43]. Lovibond, S.H. & Lovibond, P.F. (1995). Manual for the Depression Anxiety Stress Scales (2nd. Ed.) Sydney: Psychology Foundation.

[44]. Mao, A., Cheong, P. L., Van, L. K., & Tam, H. L. (2021). “I am called girl, but that doesn’t matter” -perspectives of male nurses regarding gender-related advantages and disadvantages in professional development. BMC Nursing vol. 20, Article number: 24. https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00539-w

[45]. Maravilla, N. M. A. & Tan, M. J. (2021). Philippine Mental Health Act: Just an Act? A Call to Look Into the Bi-directionality of Mental Health and Economy. Frontiers in Psychology, vol. 12 https://www.frontiersin.org/article/10.3389/fpsyg.2021.706483

[46]. Masha'al, D., Shahrour, G., & Aldalaykeh, M. (2022). Anxiety and coping strategies among nursing students returning to university during the COVID-19 pandemic. Heliyon, 8(1), e08734. https://doi.org/10.1016/j.heliyon.2022.e08734

[47]. Matthew, C.P. (2017). Stress and Coping Strategies among College Students. IOSR Journal of Humanities and Social Science. http://www.iosrjournals.org/iosr-jhss/papers/Vol.%2022%20Issue8/Version-4/I2208044044.pdf

[48]. McCarthy, B., Trace, A., O’Donovan, M., Brady-Nevin, C., Murphy, M., O’Shea, M., & O’Regan, P. (2018). Nursing and midwifery students’ stress and coping during their undergraduate education programmes: An integrative review. Nurse Education Today, 61, 197–209. https://doi.org/10.1016/j.nedt.2017.11.029

[49]. McCombes, S. (2019). Descriptive Research Design | Definition, Methods & Examples. https://www.scribbr.com/methodology/descriptive-research/

[50]. McEwen, M., & Wills, E. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer Health/Lippincott Williams & Wilkins. https://dl.uswr.ac.ir/bitstream/Hannan/141162/1/9781496351203.pdf

[51]. McLeod, S. (2015). Psychological Theories of Depression. Simply Psychology. https://www.simplypsychology.org/depression.html

[52]. Mellowed (2017). How Stress Affects Students (And What to Do About It). https://mellowed.com

[53]. MentalHelp.Net (2021). Cognitive Theories of Major Depression – Aaron Beck https://www.mentalhelp.net/depression/cognitive-theories/

[54]. Mirghani, H., & Elnour, M. (2017). The academic environment and approach to learning effects on academic performance among Sudanese medical students. MedEdPublish, 6(1). https://doi.org/10.15694/mep.2017.000037

[55]. Moscaritolo, L. M. (2019). Interventional Strategies to Decrease Nursing Student Anxiety in the Clinical Learning Environment. Journal of Nursing Education, 48(1), 17–23. https://doi.org/10.3928/01484834-20090101-08

[56]. Njim, T., Mbanga, C., & Mouemba, D. (2020). Determinants of depression among nursing students in Cameroon: a cross-sectional analysis. BMC Nurs 19, 26. https://doi.org/10.1186/s12912-020-00424-y

[57]. Nwachukwu, D. (2015). How to write a letter of permission to conduct research in an organization. https://nairaproject.com/blog/how-to-write-letter-of-permission-to-conduct-research-thesis-in-an-organization.html

[58]. Onieva-Zafra, M.D., Fernández-Muñoz, J.J., Fernández-Martínez, E. et al. (2020). Anxiety, perceived stress and coping strategies in nursing students: a cross-sectional, correlational, descriptive study. BMC Med Educ 20, 370. https://doi.org/10.1186/s12909-020-02294-z

[59]. Oswalt SB, Lederer AM, Chestnut-Steich K, Day C, Halbritter A, Ortiz D. (2020). Trends in college students’ mental health diagnoses and utilization of services, 2009–2015. Journal of American College Health. 68(1):41–51. https://pubmed.ncbi.nlm.nih.gov/30355071/

[60]. Oxley, M. (2019). Mental Illness: Is There Really A Global Epidemic. http://www.theguardian.com/society/2019

[61]. Pompilio, E. (2020). Gender Roles in Nursing. https://www.elitelearning.com/resource-center/nursing/gender-roles-in-nursing/

[62]. Pulido-Criollo, F., Cueto-Escobedo, J., & Guillén- Ruiz, G. (2018). Stress in Nursing University Students and Mental Health. In (Ed.), Health and Academic Achievement. IntechOpen. https://doi.org/10.5772/intechopen.72993

[63]. Puyat, J., Gastardo-Conaco, M.C., Natividad, J., Banal, M. A. (2021). Depressive symptoms among young adults in the Philippines: Results from a nationwide cross-sectional survey. Journal of Affective Disorders Reports, Volume 3. https://www.sciencedirect.com/science/article/pii/S2666915320300731

[64]. Rafati, F., Rafati, S., Khoshnood, Z. (2020). Perceived Stress among Iranian Nursing Students in a Clinical Learning Environment: A Cross-Sectional Study. Adv Med Educ Pract., 11:485-491. https://doi.org/10.2147/AMEP.S259557

[65]. Rathnayake, S. & Ekanayaka, J. (2016). Depression, Anxiety and Stress among Undergraduate Nursing Students in a Public University in Sri Lanka. International Journal of Caring Sciences. http://internationaljournalofcaringsciences.org/docs/31_rathnayaky_originial_9_3.pdf

[66]. Rice, V. H. (2012). Handbook of stress, coping, and health: implications for nursing research, theory, and practice (2nd ed.). Thousand Oaks: SAGE Publications.

[67]. Ritvo, P., Ahmad, F., El Morr, C., Pirbaglou, M., Moineddin, R., MVC Team (2021). A Mindfulness-Based Intervention for Student Depression, Anxiety, and Stress: Randomized Controlled Trial. JMIR Ment Health 2021;8 (1):e23491 https://mental.jmir.org/2021/1/e23491

[68]. Roberts, S. (2018). Mental Illness Is A Global Problem: We Need A Global Response. http://www.healthpovertyaction.org

[69]. Samson, P. (2020). Effect of perceived social support on stress, anxiety and depression Among Nepalese nursing students. Indian Journal of Continuing Nursing Education, 21(1), 59. https://doi.org/10.4103/ijcn.ijcn_8_20

[70]. Savitsky, B., Findling, Y., Ereli, A., & Hendel, T. (2020). Anxiety and coping strategies among nursing students during the covid-19 pandemic. Nurse education in practice, 46, 102809. https://doi.org/10.1016/j.nepr.2020.102809

[71]. Schimelpfening, N. (2020). Why Depression Is More Common in Women Than in Men. https://www.verywellmind.com/why-is-depression-more-common-in-women-1067040

[72]. Shamsaei, F., Yaghmaei, S., Sadeghian, E., Tapak, L. (2018). Survey of Stress, Anxiety and Depression in Undergraduate Nursing Students of Hamadan University of Medical Sciences. IJPN, 6 (3):26-31. http://ijpn.ir/article-1-1096-en.html

[73]. Statistic Stats (2019). Male Nursing Statistics. https://www.statisticstats.com/health/male-nursing-statistics/

[74]. Stupart, Y. (2018). How Stress Affects College Students’ Academic Performance. http://owlcation.com/academia

[75]. Substance Abuse and Mental Health Services Administration (2021). Prevention and Treatment of Anxiety, Depression, and Suicidal Thoughts and Behaviors among College Students. SAMHSA Publication. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP21-06-05-002.pdf

[76]. Tapariya, J. H. (2020). Level of stress, anxiety and depression among nursing students. International Journal of Indian Psychology, 8(2), 220-225. https://ijip.in/wp-content/uploads/2020/06/

[77]. Tartakovsky, M. (2018). Depression and Anxiety among College Students. http://psychcentral.com/lib/depression-and-anxiety-among-college-students/

[78]. Teh, C., Ngo, C., Zulkifli, R., Vellasamy, R. and Suresh, K. (2015). Depression, Anxiety and Stress among Undergraduate Students: A Cross Sectional Study. Open Journal of Epidemiology, 5, 260-268. DOI: 10.4236/ojepi.2015.54030

[79]. Temiz, Z. (2020). Nursing Students' Anxiety Levels and Coping Strategies during the COVID-19 Pandemic. Int Arch Nurs Health Care, 6:150. https://doi.org/10.23937/2469-5823/1510150

[80]. Tung, Y.J., Lo, KKH, Ho, RCM, & Tam, WSW. (2018). Prevalence of depression among nursing students: A systematic review and meta-analysis. Nurse Education Today, Volume 63, 2018, Pages 119-129, ISSN 0260-6917. https://doi.org/10.1016/j.nedt.2018.01.009

[81]. Wang, X., Hegde, S., Son, C., Keller, B., Smith, A., & Sasangohar, F. (2020). Investigating Mental Health of US College Students during the COVID-19 Pandemic: Cross-Sectional Survey Study. Journal of Medical Internet Research, 22(9), e22817. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505693/
[82]. Weissman, S. (2021). Struggling to Fill a Dangerous and Growing Labor Gap. Inside Higher Ed. https://www.insidehighered.com/news/2021/11/04/colleges-and-universities-strive-graduate-more-nurses

[83]. Werner-Seidler, A., Perry, Y., Calear, A., Newby, J., & Christensen, H. (2017). School-based depression and anxiety prevention programs for young people: A systematic review and meta-analysis. Clinical Psychology Review, Volume 51, 2017, Pages 30-47, ISSN 0272-7358. https://doi.org/10.1016/j.cpr.2016.10.005.

[84]. Wilkes, L., Cowin, L., & Johnson, M. (2015). The reasons students choose to undertake a nursing degree. Collegian (Royal College of Nursing, Australia), 22(3), 259–265. https://doi.org/10.1016/j.colegn.2014.01.003

[85]. World Health Organization (2022). Depression. https://www.who.int/news-room/fact-sheets/detail/depression

[86]. Zhao, F. F., Lei, X. L., He, W., Gu, Y. H., & Li, D. W. (2015). The study of perceived stress, coping strategy and self-efficacy of Chinese undergraduate nursing students in clinical practice. International journal of nursing practice, 21(4), 401–409. https://doi.org/10.1111/ijn.12273