Prevalence of Stress and Associated Factors Among Students in Ethiopia: a Systematic Review and Meta-analysis

Overview

Journal Front Public Health

Specialty Public Health

Date 2025 Mar 4

PMID 40034176

Authors

Anmut Endalkachew Bezie

Giziew Abere

Girum Tareke Zewude

Belay Desye

Chala Daba

Eyob Tilahun Abeje

Awoke Keleb

Affiliations

Soon will be listed here.

Abstract

Introduction: Stress is an increasing public health issue among the student population. This stress affects their academic performance, mental health, and overall well-being. As a result, we conducted a systematic review and meta-analysis to determine the pooled prevalence and associated factors of stress among students in Ethiopia.

Methods: An extensive search of electronic databases such as PubMed, Google Scholar, Semantic Scholar, HINARI, and Science Direct, cross-referencing, and Google manual search was conducted to identify cross-sectional studies published from 1998 to 2024. The preferred PRISMA guideline was used to report items for this systematic review and meta-analysis. To extract data, Microsoft Excel 16 and to analyze STATA 17 software were used. The JBI quality assessment tool was used for the included studies with medium to high-quality scores. To estimate the pooled prevalence of stress and its associated factors, a random effects model was used. The funnel plot and Egger's regression test were used to assess publication bias, and I test statistics were used to determine heterogeneity of the included studies. The protocol for this review has been registered with PROSPERO (ID: CRD42024578490).

Results: A total of 23 studies with 8,946 study participants met the inclusion criteria. The pooled prevalence of stress among students in Ethiopia was 37.64% (95% CI: 29.61-45.66; I = 98.8%). Female gender (OR = 1.82, 95% CI: 1.57-2.12), rural resident (OR = 1.51, 95% CI: 1.22-1.87), living outside university dormitory (OR = 2.02, 95% CI: 1.34-3.05), the habit of alcohol consumption (OR = 1.46, 95% CI: 1.12-1.91), being a cigarette smoker (OR = 2.36, 95% CI: 1.49-3.74), being a khat chewer (OR = 1.35, 95% CI: 1.02-1.80), working in an unfavorable environment (OR = 1.80, 95% CI: 1.20-2.71), and having poor social support (OR = 1.93, 95% CI: 1.39-2.68), were significantly associated with an increased risk of stress.

Conclusion: The findings of this systematic review and meta-analysis indicated a high prevalence of stress among students. The study identified female gender, being a rural residence, living outside a university dormitory, khat chewing, having the habit of alcohol consumption, working in an unfavorable environment, poor social support, and cigarette smoking as significant risk factors for stress. To develop coping skills and resilience, integrating mental health education into the curriculum could help students to prevent stress. Furthermore, strategies such as academic support programs, substance use reduction programs, counseling services, and stress management workshops could be beneficial.

Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024578490, CRD42024578490.

References

Macht M . How emotions affect eating: a five-way model. Appetite. 2007; 50(1):1-11. DOI: 10.1016/j.appet.2007.07.002. View

Jebessa Kumsa M, Lemu B, Nguse T . Lack of pocket money impacts Ethiopian undergraduate health science students learning activities. PLoS One. 2020; 15(12):e0243634. PMC: 7725350. DOI: 10.1371/journal.pone.0243634. View

Mekonen E, Workneh B, Ali M, Muluneh N . The Psychological Impact of COVID-19 Pandemic on Graduating Class Students at the University of Gondar, Northwest Ethiopia. Psychol Res Behav Manag. 2021; 14:109-122. PMC: 7881778. DOI: 10.2147/PRBM.S300262. View

Philip K, Bu F, Polkey M, Brown J, Steptoe A, Hopkinson N . Relationship of smoking with current and future social isolation and loneliness: 12-year follow-up of older adults in England. Lancet Reg Health Eur. 2022; 14:100302. PMC: 8743222. DOI: 10.1016/j.lanepe.2021.100302. View

Abera A, Ayalew Z, Kanko M, Bante A . Psychological problems and associated factors among high school students during COVID-19 pandemic in Sawla town, Gofa zone, southern Ethiopia. Heliyon. 2023; 9(6):e16899. PMC: 10236918. DOI: 10.1016/j.heliyon.2023.e16899. View

Ezo E, Zekiwos A, Mezgebu T, Admasu S, Birhanu B, Ossabo G . Prevalence and Associated Factors of Stress and Coping Strategies of Nursing Students During Clinical Practice in School of Nursing, Wachemo University, Ethiopia. SAGE Open Nurs. 2024; 10:23779608241272528. PMC: 11320391. DOI: 10.1177/23779608241272528. View

Anderson R . Stress at work: the current perspective. J R Soc Promot Health. 2003; 123(2):81-7. DOI: 10.1177/146642400312300211. View

Wondemagegn A, Cheme M, Kibret K . Perceived Psychological, Economic, and Social Impact of Khat Chewing among Adolescents and Adults in Nekemte Town, East Welega Zone, West Ethiopia. Biomed Res Int. 2017; 2017:7427892. PMC: 5317140. DOI: 10.1155/2017/7427892. View

Assefa Z, Haile T, Wazema D, Tafese W, Berrie F, Beketie E . Mental Health Disorders During COVID-19 Pandemic Among Southwest Ethiopia University Students: An Institutional-Based Cross-Sectional Study. SAGE Open Nurs. 2021; 7:23779608211064374. PMC: 8689431. DOI: 10.1177/23779608211064374. View

10.

McLean L, Gaul D, Penco R . Perceived Social Support and Stress: a Study of 1st Year Students in Ireland. Int J Ment Health Addict. 2022; :1-21. PMC: 8791695. DOI: 10.1007/s11469-021-00710-z. View

11.

Lisiecka A, Chimicz D, Lewicka-Zelent A . Mental Health Support in Higher Education during the COVID-19 Pandemic: A Case Study and Recommendations for Practice. Int J Environ Res Public Health. 2023; 20(6). PMC: 10049581. DOI: 10.3390/ijerph20064969. View

12.

Roohafza H, Shahnam M, Zolfaghari B, Tavassoli A, Sadeghi M, Toloei H . Stress level and smoking status in central iran: isfahan healthy heart program. ARYA Atheroscler. 2012; 6(4):144-8. PMC: 3347833. View

13.

Peng P, Hao Y, Liu Y, Chen S, Wang Y, Yang Q . The prevalence and risk factors of mental problems in medical students during COVID-19 pandemic: A systematic review and meta-analysis. J Affect Disord. 2022; 321:167-181. PMC: 9613786. DOI: 10.1016/j.jad.2022.10.040. View

14.

Worku D, Dirriba A, Wordofa B, Fetensa G . Perceived Stress, Depression, and Associated Factors among Undergraduate Health Science Students at Arsi University in 2019 in Oromia, Ethiopia. Psychiatry J. 2020; 2020:4956234. PMC: 7275200. DOI: 10.1155/2020/4956234. View

15.

Abebe A, Kebede Y, Mengistu F . Prevalence of Stress and Associated Factors among Regular Students at Debre Birhan Governmental and Nongovernmental Health Science Colleges North Showa Zone, Amhara Region, Ethiopia 2016. Psychiatry J. 2018; 2018:7534937. PMC: 6139197. DOI: 10.1155/2018/7534937. View

16.

Aronson K, Almeida D, Stawski R, Klein L, Kozlowski L . Smoking is associated with worse mood on stressful days: results from a national diary study. Ann Behav Med. 2008; 36(3):259-69. PMC: 2873683. DOI: 10.1007/s12160-008-9068-1. View

17.

Aylie N, Mekonen M, Mekuria R . The Psychological Impacts of COVID-19 Pandemic Among University Students in Bench-Sheko Zone, South-west Ethiopia: A Community-based Cross-sectional Study. Psychol Res Behav Manag. 2020; 13:813-821. PMC: 7533263. DOI: 10.2147/PRBM.S275593. View

18.

Alshoabi S, Hamid A, Gameraddin M, Suliman A, Omer A, Alsultan K . Risks of khat chewing on the cardiovascular, nervous, gastrointestinal, and genitourinary systems: A narrative review. J Family Med Prim Care. 2022; 11(1):32-36. PMC: 8930170. DOI: 10.4103/jfmpc.jfmpc_1254_21. View

19.

Belete H, Ergetie T, Ali T, Birhanu S, Belete T . Work-Related Stress and Associated Factors Among Textile Factory Employees in Northwest Ethiopia: A Cross-Sectional Study. Psychol Res Behav Manag. 2020; 13:1071-1078. PMC: 7708313. DOI: 10.2147/PRBM.S282061. View

20.

Tavolacci M, Ladner J, Grigioni S, Richard L, Villet H, Dechelotte P . Prevalence and association of perceived stress, substance use and behavioral addictions: a cross-sectional study among university students in France, 2009-2011. BMC Public Health. 2013; 13:724. PMC: 3750571. DOI: 10.1186/1471-2458-13-724. View