Prevalence Sources and Coping Strategies of Stress Among Final Year Medical Students at the University of Dongola Sudan During 2025 to 2026 Cross Sectional Study

Prevalence Sources and Coping Strategies of Stress Among Final Year Medical Students at the University of Dongola Sudan During 2025 to 2026 Cross Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence Sources and Coping Strategies of Stress Among Final Year Medical Students at the University of Dongola Sudan During 2025 to 2026 Cross Sectional Study Kamal A. A. Mohammed, Rowaa G. A. , Ahmed, Anfal A. O. Ibrahim This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8881115/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Medical education is globally recognized as a high-stress environment, yet localized data on final-year students in Northern Sudan remains scarce. This study investigated the prevalence, sources, and coping mechanisms of stress among final-year medical students at the University of Dongola. Methods A cross-sectional study was conducted using the Perceived Stress Scale (PSS-10) and a structured questionnaire to identify academic and non-academic stressors. Statistical associations were analyzed using Chi-square ( $ \chi^2 $ ) and Phi ( $ \Phi $ ) tests. Results The findings revealed that 77% of respondents experienced moderate-to-high stress levels (67% moderate; 10% high), with a mean PSS score of $ 18.17 \pm 6.56 $ . Exam pressure (73%) and academic workload (61%) were the dominant stressors. Significant associations were found between high stress and exam pressure ( $ \chi^2 = 17.39, p < 0.001 $ ) and workload ( $ \chi^2 = 6.01, p = 0.014 $ ). Prayer (67%) and social interaction (46%) were the primary coping strategies. Physical exercise and social support showed significant protective effects against high stress levels ( $ p < 0.001 $ ). Discussion While the Yerkes-Dodson Law suggests that moderate pressure can enhance performance, the 77% prevalence rate indicates that students have surpassed their "peak" threshold and entered a state of distress. Conclusion Academic factors, rather than personal or financial issues, dominate the stress profile of final-year students at Dongola. There is an urgent need for institutionalized mental health support and curriculum reforms to balance academic rigor with student well-being. Academic Stress Coping Strategies Medical Students Sudan Yerkes-Dodson Law Figures Figure 1 Figure 2 INTRODUCTION 1.1 Background The concept of stress is frequently defined as a state of psychological trauma or physiological tension that arises when an individual perceives that the demands of their environment exceed their available coping resources. These coping mechanisms—the cognitive and behavioral efforts used to manage internal and external pressures—are not universal; they vary significantly from one individual to another and are shaped by a complex interplay of personality traits, past experiences, and environmental support systems (Lazarus and Folkman, 1984 ). In the pedagogical landscape, academic stress is specifically characterized as a product of the interaction between rigorous academic demands and the adaptive materials or psychological resilience available to the student (Misra and McKean, 2000 ). Within medical education, several "stressors" have been consistently identified as primary triggers. These include the pervasive fear of academic failure, feelings of personal inadequacy within a highly competitive cohort, and dissatisfaction with teaching-learning activities. Furthermore, the quality of the teacher-pupil relationship and the availability of adequate learning resources at home significantly dictate a student’s stress levels (Sreeramareddy et al., 2007 ). The relationship between stress and achievement is nuanced. Historically, it has been observed that a moderate degree of stress—often referred to as "eustress"—can act as a catalyst for performance. Research indicates that students experiencing high or moderate stress may perform better than those with negligible stress, as the pressure fosters alertness and ensures the timely completion of complex tasks (Yerkes and Dodson, 1908 ; Kaplan and Sadock, 2007 ). However, when stress becomes chronic or overwhelming, it crosses into "distress." Excessive stress is a precursor to debilitating psychosocial and emotional consequences, including generalized anxiety, clinical depression, social withdrawal, and, in extreme cases, suicidal ideation (Dyrbye, Thomas and Shanafelt, 2006 ; Rotenstein et al., 2016 ). Globally, the mental health of medical students is a growing concern; a comprehensive meta-analysis revealed that the prevalence of depressive symptoms among this group is approximately 27.2%, with 11.1% reporting suicidal ideation—rates significantly higher than their non-medical peers (Tam, Lo and Pacheco, 2019 ). Final-year medical students represent a particularly vulnerable demographic within the university ecosystem. As they stand at the threshold of professional practice, they face a "triple burden": an immense academic workload, increasing clinical responsibilities involving real patient care, and the looming pressure of high-stakes final examinations. This accumulation of pressure can severely impair mental health, diminish academic performance, and—most critically—compromise the quality of patient care they provide (Fares et al., 2016 ). While various coping strategies—ranging from healthy lifestyle choices to maladaptive behaviors—exist, there is a notable lack of localized data. Specifically, at the University of Dongola in Sudan, little is known about the current prevalence of stress or the specific mechanisms these students employ to survive their final year. This knowledge gap prevents the institution from identifying students at risk and implementing effective support systems. This study is essential for several reasons. First, by identifying the root causes of stress at the University of Dongola, the faculty can better support academic performance and ensure that graduates possess the "professional readiness" required for their internship year (Hamza and El-Hadi, 2021 ). Second, the study aims to promote the holistic well-being of students, recognizing that mental health is a prerequisite for physical health and long-term career sustainability (Steptoe and Wardle, 2001 ). Furthermore, the findings will serve as a foundational guide for creating context-specific interventions, such as tailored wellness programs and counseling services that respect the cultural and economic realities of Northern Sudan. Finally, this research will contribute valuable data to the regional literature on medical student stress, filling a gap in the Sudanese context and providing a benchmark for future studies in similar environments (El-Masry and Seyam, 2013 ). Over the past decade, there has been increasing global attention on psychological stress among medical students. Evidence consistently demonstrates that academic and social pressures significantly affect both mental well-being and academic performance. A study conducted in Saudi Arabia reported that 82% of respondents experienced academic stress, 38.7% financial stress, and 56% social stress (Bamuhair et al., 2015 ). Female students exhibited higher perceived stress than males but adopted more coping strategies. Notably, 30% of participants used alcohol or illicit drugs, while 94.2% relied on prayer and 82% engaged in social interactions with friends as coping mechanisms. Similarly, a cross-sectional study in Pakistan found that 23.3% of respondents had psychological morbidity, and 52.3% demonstrated distress (Imran et al., 2016 ). In India, Anuradha et al. ( 2017 ) reported that heavy academic workloads, fear of failure, and personal issues such as loneliness were the main sources of stress. The mean perceived stress score was $ 25.64 \pm 5.44 $ . At Rabigh Medical College, Gazzaz et al. ( 2018 ) identified a stress prevalence of 59.2%, with academic stressors being significantly associated with academic performance ( $ p < 0.05 $ ). In Nigeria, Fasoro et al. ( 2019 ) found that 67% of medical students perceived their studies as stressful, with female students more affected than males. In South Africa, Mahlangu, Mokoena and Ntuli ( 2024 ) reported that 25% of students experienced symptoms of perceived stress after the COVID-19 pandemic, identifying age, gender, and marital status as significant predictors. A multicenter study across six Sudanese medical schools found that time pressure, heavy workload, and fear of failure were the main stressors (Ragab et al., 2021 ). At the University of Gezira, 72.9% of medical students experienced moderate stress and 16.1% severe stress, with the most frequent coping mechanism being sleeping (Elsharief, 2023 ). Currently, no published data are available regarding stress and coping strategies among medical students at the University of Dongola. 1.2. Objective The primary objective of this study was to evaluate the prevalence and severity of perceived stress among final-year medical students at the University of Dongola. Additionally, the study aimed to identify the predominant academic and non-academic stressors and to evaluate the effectiveness of the coping strategies utilized by students to mitigate these pressures. Methods 2.1 Study Design and Setting A descriptive, cross-sectional institutional-based study was conducted among final-year medical students at the Faculty of Medicine, University of Dongola, Sudan, during the 2024-2025 academic session. 2.2 Population and Sampling The study population consisted of all final-year medical students. A total of 100 students were recruited using a convenient sampling technique. Inclusion criteria included all students currently registered in their final year who consented to participate. Students who were absent during the data collection period or declined participation were excluded. 2.3 Data Collection Tools Data were collected using a self-administered, structured questionnaire consisting of three parts: Socio-demographics: Age, gender, and residency. Perceived Stress Scale (PSS-10): A validated 10-item instrument used to measure the degree to which situations in one’s life are appraised as stressful. Items were scored on a 5-point Likert scale (0 = Never to 4 = Very Often). Total scores range from 0 to 40, with scores categorized as low (0–13), moderate (14–26), or high (27–40) stress. Stressors and Coping Checklist: A custom list of academic (e.g., exams, workload) and non-academic (e.g., finances) stressors, alongside common coping mechanisms. 2.4 Theoretical Framework The study utilized the Yerkes-Dodson Law as a conceptual framework to interpret the relationship between academic pressure and student performance. This model posits that while moderate stress can be beneficial (eustress), excessive pressure leads to a decline in performance and psychological distress. 2.5 Statistical Analysis Data were analyzed using SPSS version [Insert Version, e.g., 26.0]. Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize the data. The Chi-square ($\chi^2$) test was employed to determine associations between categorical variables (stressors/coping) and stress levels. The Phi ($\Phi$) coefficient was used to measure the effect size of these associations. A p-value of < 0.05 was considered statistically significant. 2.6 Ethical Considerations All procedures involving human participants were performed in accordance with institutional guidelines and the Declaration of Helsinki.Ethical approval was obtained from the Ethical Committee of the Faculty of Medicine, University of Dongola (Approval Number: p/1/2025). All participants were provided with a clear explanation of the study’s purpose, the voluntary nature of their participation, and their right to withdraw at any time without penalty. Informed written consent was obtained from each student before data collection. To ensure confidentiality and anonymity, no identifying information (such as names or ID numbers) was collected, and all data were stored in a password-protected digital format accessible only to the primary researchers. 2.7 Inclusion and Exclusion Criteria 2.7.1 Inclusion Criteria Students officially registered in the final year (6th year) of the MBBS program at the University of Dongola. Students present on campus during the data collection period. Students who voluntarily provided informed consent to participate. 2.7.2 Exclusion Criteria Students in earlier years of medical training (Years 1–5). Students on official leave or those who were absent due to illness during the study period. Incomplete questionnaires (missing >20% of the PSS-10 responses). RESULTS Socio-demographic Characteristics Table 4.1.1 summarizes the socio-demographic characteristics of the study population, consisting of 100 final-year medical students at University of Dongola, Dongola, NS, Sudan. Most participants were female (77.0%, n=77) while males constituted 23.0% (n=23). The majority of students were aged between 20 and 25 years (82.0%, n=82), and the remainder were aged 26–30 years (18.0%, n=18). Perceived Stress, Sources, and Coping Strategies Table 4.2.1 presents a comprehensive descriptive analysis summary of PSS statements. Regarding the feeling upset by unexpected events, the distribution shows considerable variability, with nearly half (45.0%) reporting this occurred “sometimes” and a smaller group (29.0%) experiencing it “fairly often.” Notably, 9.0% indicated that they were “very often” upset by unexpected events. When asked about controlling important things in life (item 2), 44.0% experienced difficulties “sometimes,” and 22.0% “fairly often.” However, almost one-quarter (23.0%) did “never” feel unable to control these aspects. Concerning the statement “feeling nervous or stressed’, it revealed that 45.0% claimed they were “not at all” nervous or stressed over the last month, although 40.0% (combined) acknowledged “fairly often” or “very often” stress. Conversely, the statement ‘confidence in handling personal problems’ had 57.0% answering “fairly often” or “very often,” indicating the majority felt at least somewhat capable of managing challenges. The sense of well-being similarly skewed positive, with 45.0% and 35.0% respectively selecting “sometimes” and “fairly often” for the perception that things were going their way. Yet, 10.0% rarely felt in control. In terms of coping capacity (item 6), 43.0% “sometimes” felt unable to cope, with 23.0% reporting “fairly often” or “very often”. Irritability control also revealed notable resilience: 45.0% and 36.0% of respondents, respectively, demonstrated confidence by stating “fairly often” or “very often.” Anger driven by uncontrollable events was reported “sometimes” or “fairly often” for 64.0% of respondents. In addition, 47.0% faced difficulties piling up too high “sometimes” or “fairly often,” and 8.0% “very often”. —signifying commonality of workload stress. The overall PSS score showed a near-normal pattern with a mean (SD) score of 18.17±6.56 (Figure 4.2.1). Regarding the stress status stratification,; 23.0% exhibited low or no stress, 67.0% were categorized as moderate stress, and 10.0% reported high stress levels (Figure 4.2.2). Concerning sources of academic stress (Table 4.2.2), exam pressure was the most frequently reported stressor (73.0%, n=73), followed by academic workload (61.0%, n=61) and uncertainty about career future (36.0%, n=36). Financial problems affected 32.0% (n=32), while difficulties with social relationships (24.0%, n=24) and health issues (10.0%, n=10) were less common. A high proportion of participants (86.0%, n=86) acknowledged that stress negatively affected their academic performance. Students reported employing various coping strategies: meditation or prayer (67.0%, n=67), sleeping or resting (51.0%, n=51), talking to friends or family (46.0%, n=46), and physical exercise (17.0%, n=17) were most common. Less frequently, students used stimulants like smoking/tobacco (11.0%, n=11), ignored the problem (11.0%, n=11), ate more (15.0%, n=15), or sought professional help (2.0%, n=2). Most perceived their coping method as effective (82.0%, n=82), and two-thirds (67.0%, n=67) expressed desire for formal psychological support or training. Impact of Academic Stress Sources on Perceived Stress Analysis of associations between sources of academic stress and perceived stress levels is presented in Table 4.3.1. The strongest and most statistically significant positive associations was exam pressure, with 87.7% of students who reported experiencing exam pressure categorized in the moderate or high stress group, compared to only 48.1% among those without exam pressure. This association was statistically significant (χ² = 17.39, df = 1, p < 0.001), and the corresponding effect size (Phi = 0.417) indicated a large magnitude of association. Academic workload also demonstrated a significant positive relationship with perceived stress. Among students citing academic workload as a stressor, 85.2% were found in the moderate or high stress group, compared to 64.1% of those who did not identify workload as a stressor (χ² = 6.01, df = 1, p = 0.014)., with a moderate effect size (Phi = 0.245). By contrast, sources such as financial problems, uncertainty about career future, social relationship difficulties, and health issues did not demonstrate statistically significant associations with perceived stress level in this sample (all p > 0.05, Phi < 0.2). Impact of Coping Strategies on Perceived Stress The impact of various coping strategies on perceived stress levels among final-year medical students is summarized in Table 4.4.1. Physical exercise was found to have a statistically significant association with lower levels of perceived stress: 58.8% of those who practiced physical exercise fell into the low or no stress group, compared to only 15.7% among students who did not use this strategy (χ² = 14.84, df = 1, p < 0.001), with a large effect size (Phi = -0.385). Similarly, talking to friends or family demonstrated a significant and substantial impact. Of the students who engaged in this coping method, 39.1% reported low or no stress, contrasting with only 9.3% of those who did not talk to friends or family (χ² = 12.52, df = 1, p < 0.001, Phi = -0.354). Other coping strategies—including sleeping or resting, meditation or prayer, use of stimulants (smoking, tobacco), ignoring the problem, eating, and seeking professional help—were not significantly associated with stress level (all p > 0.05; Phi effect sizes range from -0.013 to 0.192, all small to negligible). Discussion This study assessed the levels, sources, and coping strategies of stress among final-year medical students at the University of Dongola. The findings revealed that 67% of respondents experienced moderate stress, 10% high stress, and only 23% low or no stress. These results confirm that medical education remains psychologically demanding and emotionally taxing, as documented globally. Perceived Stress and Comparative Analysis The mean perceived stress score ($18.17 \pm 6.56$) observed in this study is consistent with the moderate range reported across medical schools in Sudan and internationally. At the University of Gezira, 72.9% of medical students experienced moderate stress and 16.1% severe stress (Elsharief, 2023). Likewise, Ragab et al. (2021) found that Sudanese medical students across six universities faced intense pressure due to workload, time constraints, and fear of failure. Comparable findings were reported elsewhere in the region and beyond: in Pakistan, over half of the respondents exhibited psychological distress (Imran et al., 2016); in India, academic workload and fear of failure were major contributors (Anuradha et al., 2017); and in Bangladesh, 68.6% of final-year medical students displayed stress symptoms (Alam et al., 2025). In Saudi Arabia, several studies recorded stress prevalence rates between 59% and 82% among medical students (Bamuhair et al., 2015; Gazzaz et al., 2018; Salih et al., 2023), while in Nepal, over half of students reported being stressed (Paudel et al., 2024). These findings align with the results from Dongola and affirm that medical students worldwide experience high stress regardless of differences in curriculum or socioeconomic setting. While historical models like the Yerkes-Dodson Law suggest that moderate pressure can enhance habit-formation and alertness, the high prevalence of moderate-to-severe stress found in this study (77%) indicates that final-year students at Dongola have likely surpassed their peak performance threshold, entering a state of psychological distress that requires institutional support. One notable finding from the current study was that most students felt “sometimes” or “fairly often” upset or unable to cope with the demands of their studies. However, the majority also reported confidence in handling personal problems, which indicates a degree of resilience. Such duality—high stress yet functional coping—is common among medical trainees, as seen in previous work from Brazil and Syria (Al Houri et al., 2023; Murakami et al., 2025), where students maintained acceptable academic performance despite ongoing psychological strain. Sources of Academic Stress Exam pressure and academic workload were the dominant sources of stress, affecting 73% and 61% of participants, respectively. This aligns with previous Sudanese research identifying similar stressors (Ragab et al., 2021; Elsharief, 2023). Academic overload has also been repeatedly cited as a key source of stress in Saudi Arabia (Bamuhair et al., 2015; Gazzaz et al., 2018; Salih et al., 2023) and India (Anuradha et al., 2017), where students often report anxiety about performance, insufficient rest, and limited recreational time. The statistical analyses in this study confirmed significant associations between exam pressure ($\chi^2 = 17.39, p < 0.001, \text{Phi} = 0.417$) and workload ($\chi^2 = 6.01, p = 0.014, \text{Phi} = 0.245$) with higher perceived stress levels. These results echo the findings of Gazzaz et al. (2018), who reported that academic stress was significantly correlated with academic performance ($p < 0.05$). In Vietnam, Nguyen et al. (2024) observed that concerns about future competence and academic success were major determinants of stress intensity. In contrast, non-academic stressors such as financial problems, health issues, and social difficulties showed no statistically significant association with perceived stress. This pattern has been noted previously in Brazil (Murakami et al., 2025), suggesting that academic factors dominate the emotional landscape of medical students, often eclipsing other stress domains. Coping Strategies Students at Dongola employed various coping strategies, with prayer or meditation (67%), sleeping or resting (51%), and social interaction (46%) being the most common. These coping styles are consistent with patterns in Islamic cultural contexts, where religious practices serve as a primary coping mechanism (Bamuhair et al., 2015; Salih et al., 2023). The preference for emotional and religious coping over problem-focused approaches mirrors findings from Saudi Arabia and Nepal (Bamuhair et al., 2015; Paudel et al., 2024). Significant negative associations were observed between stress levels and both physical exercise ($\chi^2 = 14.84, p < 0.001, \text{Phi} = -0.385$) and talking to friends or family ($\chi^2 = 12.52, p < 0.001, \text{Phi} = -0.354$), indicating their protective effect. Similar results have been reported in studies from Pakistan (Imran et al., 2016) and Vietnam (Nguyen et al., 2024), where social support and active coping strategies mitigated stress. Encouragingly, the majority (82%) perceived their coping mechanisms as effective, yet 67% expressed a desire for structured psychological support—highlighting the unmet need for formal counseling services. Notably, maladaptive strategies such as substance use, avoidance, and overeating were relatively uncommon ($<15\%$), unlike in some Western settings (Graves et al., 2021), suggesting a more conservative and socially moderated coping culture among Sudanese students. Gender Differences Although gender-specific data were not the primary focus of this study, the predominance of female participants (77%) warrants mention. Previous studies consistently show that female medical students report higher perceived stress and employ more emotion-focused coping strategies (Bamuhair et al., 2015; Graves et al., 2021; Fasoro et al., 2019; Mahlangu et al., 2024). The overrepresentation of women in this sample may partially explain the high prevalence of moderate stress observed. Implications The findings underscore the need for institutional interventions aimed at reducing academic stress and promoting student well-being. Universities should integrate stress management workshops, academic advising systems, and peer mentoring programs into the medical curriculum. Promoting physical activity, social connectedness, and open communication can enhance resilience. Additionally, incorporating counseling and psychological support services would address the gap in professional mental health access noted among participants. Conclusion Final-year medical students at the University of Dongola experience significant psychological pressure, with 77% reporting moderate-to-high stress levels. While academic stressors—specifically exam pressure and heavy workloads—are the primary drivers of this distress, students demonstrate a cultural reliance on religious coping and social support. While historical models like the Yerkes-Dodson Law suggest that moderate pressure can enhance habit-formation and alertness, the high prevalence of distress found in this study indicates that these students have surpassed their peak performance threshold. Without institutional intervention, this level of chronic stress risks compromising not only the students' mental health but also the quality of patient care they will provide as future clinicians. Recommendation : Review the examination schedule to prevent the "clustering" of high-stakes tests, which students identified as their primary source of stress. Establish a confidential counseling unit on campus to provide professional mental health support specifically for medical students. Integrate stress management workshops into the curriculum to teach students time management, mindfulness, and healthy coping mechanisms. Improve access to recreational and sports facilities, as your data proved that physical exercise significantly reduces perceived stress levels ( $ \chi^2 = 14.84 $ ). Implement a faculty-student mentorship program to help final-year students navigate the transition between academic study and clinical responsibility. Promote social connectedness through student-led wellness committees, acknowledging that talking to friends and family acts as a vital protective factor. Foster a culture of "professional readiness" by providing clearer clinical guidelines, reducing the anxiety associated with "unclear assignments." Develop a national framework for student wellness in collaboration with other Sudanese medical schools to standardize mental health support across the region. Limitations This study has several limitations that should be considered when interpreting the results. First, the cross-sectional design provides a snapshot of stress at a single point in time, which prevents the establishment of a causal relationship between specific stressors and long-term psychological outcomes. Second, the reliance on self-reported data may introduce social desirability bias, where students might underreport maladaptive coping behaviors (such as substance use) or overreport positive ones (such as prayer). Third, the study was conducted at a single institution, the University of Dongola, meaning the findings may not be fully generalizable to medical students in other regions of Sudan or different educational contexts. Finally, while the Yerkes-Dodson Law provides a theoretical framework for the findings, this study did not objectively measure academic performance (e.g., GPA or exam scores) to correlate it directly with stress levels. Declarations Ethics approval and consent to participate: This study was approved by the Ethics Committee of the Faculty of Medicine, University of Dongola (Reference No: P/1/2025) Informed consent was obtained from all individual participants included in the study. Consent for publication: Not applicable. Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Clinical Trial Number : Not applicable. Funding : No funding was received for this study. Authors' contributions : Kamal A. A. Mohammed designed the study, performed the statistical analysis and drafted the manuscript. Rowaa G. A. Ahmed and Anfal A. O. Ibrahim Collected data, wrote the initial draft. All authors read and approved the final manuscript. 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Tables Table 4.1.1: Socio-demographic Characteristics of Final-Year Medical students at University of Dongola, Dongola, NS, Sudan, 2025 (n=100) Variable N % Sex Male 23 23.0 Female 77 77.0 Age (years) 20-25 82 82.0 26–30 18 18.0 Table 4..2.1: Frequency Distribution of Perceived Stress Scale Responses among Final-Year Medical students at University of Dongola, Dongola, NS, Sudan, 2025 (n=100) PSS Statement Summary Options 0 (N) 1 (AN) 2 (S) 3 (FO) 4 (VO) Upset by unexpected events 3 (3.0%) 14 (14.0%) 45 (45.0%) 29 (29.0%) 09 (9.0%) Unable to control important things 23 (23.0%) 5 (5.0%) 44 (44.0%) 22 (22.0%) 06 (6.0%) Felt nervous or stressed 45 (45.0%) 14 (14.0%) 01 (1.0%) 29 (29.0%) 11 (11.0%) Confident about handling personal problems 05 (5.0%) 10 (10.0%) 28 (28.0%) 45 (45.0%) 12 (12.0%) Felt things were going your way 03 (3.0%) 8 (8.0%) 44 (44.0%) 35 (35.0%) 10 (10.0%) Could not cope with all you had to do 12 (12.0%) 22 (22.0%) 43 (43.0%) 14 (14.0%) 9 (9.0%) Able to control irritations 6 (6.0%) 15 (15.0%) 41 (41.0%) 27 (27.0%) 11 (11.0%) Felt on top of things 03 (3.0%) 18 (18.0%) 43 (43.0%) 28 (28.0%) 8 (8.0%) Angered by things outside control 03 (3.0%) 21 (21.0%) 42 (42.0%) 22 (22.0%) 12 (12.0%) Difficulties piling up too high 10 (10.0%) 26 (26.0%) 39 (39.0%) 17 (17.0%) 08 (8.0%) Table 4..2.2: Frequency Distribution of Sources of Academic Stress, Stress Effects, and Coping Strategies among Final-Year Medical Students at University of Dongola, Dongola, NS, Sudan, 2025 (n=100) Variable N % Sources of academic stress Financial problems 32 32.0 Exam pressure 73 73.0 Academic workload 61 61.0 Uncertainty about career future 36 36.0 Social relationships 24 24.0 Health issues 10 10.0 Stress effects academic performance Yes 86 86.0 No 14 14.0 Not sure Coping strategies during stress Physical exercise 17 17.0 Talking to friends or family 46 46.0 Sleeping or resting 51 51.0 Meditation or prayer 67 67.0 Use of stimulants (smoking, tobacco) 11 11.0 Ignoring the problem 11 11.0 Eating 15 15.0 Seeking help from mental health professional 2 2.0 Perceived effectiveness of coping method Effective 82 82.0 Not effective 18 18.0 Desire for psychological support or training Yes 67 67.0 No 33 33.0 Table 4.3.1: Association of Sources of Academic Stress with Perceived Stress Levels among Final-Year Medical Students at University of Dongola, Dongola, NS, Sudan, 2025 (n=100) Source of Academic Stress Perceived Stress χ² (df) P-value Phi No or Low Stress Moderate or High Stress Financial Problems Yes 6 (18.8) 26 (81.3) 0.48 (1) 0.488 0.069 No 17 (25.0) 51 (75.0) Exam Pressure Yes 9 (12.3) 64 (87.7) 17.39 (1) <0.001 0.417 No 14 (51.9) 13 (48.1) Academic Workload Yes 9 (14.8) 52 (85.2) 6.01 (1) 0.014 0.245 No 14 (35.9) 25 (64.1) Uncertainty about Career Future Yes 10 (27.8) 26 (72.2) 0.73 (1) 0.394 -0.085 No 13 (20.3) 51 (79.7) Social Relationships Yes 3 (12.5) 21 (87.5) 1.97 (1) 0.161 0.140 No 20 (26.3) 56 (73.7) Health Issues Yes 0 (0.0) 10 (100.0) 3.32 (1) 0.068 0.182 No 23 (25.6) 67 (74.4) Table 4.4.1: Association of Coping Strategies of Academic Stress with Perceived Stress Levels among Final-Year Medical Students at University of Dongola, Dongola, NS, Sudan, 2025 (n=100) Coping Strategies of Academic Stress Perceived Stress χ² (df) P-value Phi No or Low Stress Moderate or High Stress Physical exercise Yes 10 (58.8) 7 (41.2) 14.84 (1) <0.001 -0.385 No 13 (15.7) 70 (84.3) Talking to friends or family Yes 18 (39.1) 28 (60.9) 12.52 (1) <0.001 -0.354 No 5 (9.3) 49 (90.7) Sleeping or resting Yes 12 (23.5) 39 (76.5) 0.02 (1) 0.898 -0.013 No 11 (22.4) 38 (77.6) Meditation or prayer Yes 15 (22.4) 52 (77.6) 0.04 (1) 0.836 0.021 No 8 (24.2) 25 (75.8) Use of stimulants (smoking, tobacco) Yes 2 (18.2) 9 (81.8) 0.16 (1) 0.687 0.040 No 21 (23.6) 68 (76.4) Ignoring the problem Yes 0 (0.0) 11 (100.0) 3.69 (1) 0.055 0.192 No 23 (25.8) 66 (74.2) Eating Yes 4 (26.7) 11 (73.3) 0.13 (1) 0.714 -0.037 No 19 (22.4) 66 (77.6) Seeking help from mental health professional Yes 1 (50.0) 1 (50.0) 0.84 (1) 0.359 -0.092 No 22 (22.4) 76 (77.6) Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 15 Apr, 2026 Reviews received at journal 10 Apr, 2026 Reviews received at journal 01 Apr, 2026 Reviewers agreed at journal 01 Apr, 2026 Reviewers agreed at journal 01 Apr, 2026 Reviewers agreed at journal 30 Mar, 2026 Reviews received at journal 24 Mar, 2026 Reviewers agreed at journal 16 Mar, 2026 Reviewers invited by journal 16 Mar, 2026 Editor assigned by journal 04 Mar, 2026 Submission checks completed at journal 03 Mar, 2026 First submitted to journal 03 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Mohammed","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYBACCRDxoIJNjoGB8QGQwwziGxDWknCGzxio2oAELYltcokNRGuRbD+d+CHhjFn6huPNjDcYKqwTG/gPb8CrRZond7NEQkVa7oYzh5ktGM6kJzZIpBXg1SLHkLtBIuHMsdwNN/KPSTC2HQZq4cHvMDn+t5t/JLb9Tze4kcwmwfgPqIX/DH4t0hK52yQS29gSIFoagFoYcgh4f8bbbRYJZ9gMZ4L8knAs3biNkF8kzuduvvGhgk2eDxRiH2qsZfsJhRgqSABiNhLUj4JRMApGwSjAAQDTfEjm062JtQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Dongola","correspondingAuthor":true,"prefix":"","firstName":"Kamal","middleName":"A. A.","lastName":"Mohammed","suffix":""},{"id":607014795,"identity":"f59d9241-8b85-401d-9061-c76bc9955820","order_by":1,"name":"Rowaa G. A. , Ahmed","email":"","orcid":"","institution":"University of Dongola","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"Rowaa G.","lastName":"A.","suffix":""},{"id":607014796,"identity":"a4a62aa6-9049-4094-9ab7-2fe32309452d","order_by":2,"name":"Anfal A. O. Ibrahim","email":"","orcid":"","institution":"University of Dongola","correspondingAuthor":false,"prefix":"","firstName":"Anfal","middleName":"A. O.","lastName":"Ibrahim","suffix":""}],"badges":[],"createdAt":"2026-02-14 15:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8881115/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8881115/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104997112,"identity":"1123d40d-808a-47fe-9cbb-ca69c8654fa2","added_by":"auto","created_at":"2026-03-19 16:18:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":77939,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 4.2.1: Overall Perceived Stress Scale Scores among Final-Year Medical Students at University of Dongola, Dongola, NS, Sudan, 2025 (n=100)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8881115/v1/73934f17aebff485f968cff2.png"},{"id":104997113,"identity":"60b22f39-4cc6-4791-9889-1c2d0f6c3331","added_by":"auto","created_at":"2026-03-19 16:18:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":151317,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 4.2.2: Perceived Stress Status among Final-Year Medical Students at University of Dongola, Dongola, NS, Sudan, 2025 (n=100)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8881115/v1/17ace49ef43105998ad0fa51.png"},{"id":105035710,"identity":"c20b017c-dc58-4f85-80e0-18fa22af523e","added_by":"auto","created_at":"2026-03-20 07:26:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1803680,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8881115/v1/111b6dac-217d-41cf-a6a6-bfd2150dffec.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence Sources and Coping Strategies of Stress Among Final Year Medical Students at the University of Dongola Sudan During 2025 to 2026 Cross Sectional Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Background\u003c/h2\u003e \u003cp\u003eThe concept of stress is frequently defined as a state of psychological trauma or physiological tension that arises when an individual perceives that the demands of their environment exceed their available coping resources. These coping mechanisms\u0026mdash;the cognitive and behavioral efforts used to manage internal and external pressures\u0026mdash;are not universal; they vary significantly from one individual to another and are shaped by a complex interplay of personality traits, past experiences, and environmental support systems (Lazarus and Folkman, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e1984\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the pedagogical landscape, academic stress is specifically characterized as a product of the interaction between rigorous academic demands and the adaptive materials or psychological resilience available to the student (Misra and McKean, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Within medical education, several \"stressors\" have been consistently identified as primary triggers. These include the pervasive fear of academic failure, feelings of personal inadequacy within a highly competitive cohort, and dissatisfaction with teaching-learning activities. Furthermore, the quality of the teacher-pupil relationship and the availability of adequate learning resources at home significantly dictate a student\u0026rsquo;s stress levels (Sreeramareddy et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe relationship between stress and achievement is nuanced. Historically, it has been observed that a moderate degree of stress\u0026mdash;often referred to as \"eustress\"\u0026mdash;can act as a catalyst for performance. Research indicates that students experiencing high or moderate stress may perform better than those with negligible stress, as the pressure fosters alertness and ensures the timely completion of complex tasks (Yerkes and Dodson, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e1908\u003c/span\u003e; Kaplan and Sadock, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). However, when stress becomes chronic or overwhelming, it crosses into \"distress.\" Excessive stress is a precursor to debilitating psychosocial and emotional consequences, including generalized anxiety, clinical depression, social withdrawal, and, in extreme cases, suicidal ideation (Dyrbye, Thomas and Shanafelt, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Rotenstein et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Globally, the mental health of medical students is a growing concern; a comprehensive meta-analysis revealed that the prevalence of depressive symptoms among this group is approximately 27.2%, with 11.1% reporting suicidal ideation\u0026mdash;rates significantly higher than their non-medical peers (Tam, Lo and Pacheco, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinal-year medical students represent a particularly vulnerable demographic within the university ecosystem. As they stand at the threshold of professional practice, they face a \"triple burden\": an immense academic workload, increasing clinical responsibilities involving real patient care, and the looming pressure of high-stakes final examinations. This accumulation of pressure can severely impair mental health, diminish academic performance, and\u0026mdash;most critically\u0026mdash;compromise the quality of patient care they provide (Fares et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile various coping strategies\u0026mdash;ranging from healthy lifestyle choices to maladaptive behaviors\u0026mdash;exist, there is a notable lack of localized data. Specifically, at the University of Dongola in Sudan, little is known about the current prevalence of stress or the specific mechanisms these students employ to survive their final year. This knowledge gap prevents the institution from identifying students at risk and implementing effective support systems.\u003c/p\u003e \u003cp\u003eThis study is essential for several reasons. First, by identifying the root causes of stress at the University of Dongola, the faculty can better support academic performance and ensure that graduates possess the \"professional readiness\" required for their internship year (Hamza and El-Hadi, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSecond, the study aims to promote the holistic well-being of students, recognizing that mental health is a prerequisite for physical health and long-term career sustainability (Steptoe and Wardle, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). Furthermore, the findings will serve as a foundational guide for creating context-specific interventions, such as tailored wellness programs and counseling services that respect the cultural and economic realities of Northern Sudan. Finally, this research will contribute valuable data to the regional literature on medical student stress, filling a gap in the Sudanese context and providing a benchmark for future studies in similar environments (El-Masry and Seyam, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOver the past decade, there has been increasing global attention on psychological stress among medical students. Evidence consistently demonstrates that academic and social pressures significantly affect both mental well-being and academic performance.\u003c/p\u003e \u003cp\u003eA study conducted in Saudi Arabia reported that 82% of respondents experienced academic stress, 38.7% financial stress, and 56% social stress (Bamuhair et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Female students exhibited higher perceived stress than males but adopted more coping strategies. Notably, 30% of participants used alcohol or illicit drugs, while 94.2% relied on prayer and 82% engaged in social interactions with friends as coping mechanisms. Similarly, a cross-sectional study in Pakistan found that 23.3% of respondents had psychological morbidity, and 52.3% demonstrated distress (Imran et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn India, Anuradha et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) reported that heavy academic workloads, fear of failure, and personal issues such as loneliness were the main sources of stress. The mean perceived stress score was \u003cspan\u003e$\u003c/span\u003e25.64 \\pm 5.44\u003cspan\u003e$\u003c/span\u003e. At Rabigh Medical College, Gazzaz et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) identified a stress prevalence of 59.2%, with academic stressors being significantly associated with academic performance (\u003cspan\u003e$\u003c/span\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003cspan\u003e$\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Nigeria, Fasoro et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) found that 67% of medical students perceived their studies as stressful, with female students more affected than males. In South Africa, Mahlangu, Mokoena and Ntuli (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) reported that 25% of students experienced symptoms of perceived stress after the COVID-19 pandemic, identifying age, gender, and marital status as significant predictors.\u003c/p\u003e \u003cp\u003eA multicenter study across six Sudanese medical schools found that time pressure, heavy workload, and fear of failure were the main stressors (Ragab et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). At the University of Gezira, 72.9% of medical students experienced moderate stress and 16.1% severe stress, with the most frequent coping mechanism being sleeping (Elsharief, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Currently, no published data are available regarding stress and coping strategies among medical students at the University of Dongola.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2. Objective\u003c/h2\u003e \u003cp\u003eThe primary objective of this study was to evaluate the prevalence and severity of perceived stress among final-year medical students at the University of Dongola. Additionally, the study aimed to identify the predominant academic and non-academic stressors and to evaluate the effectiveness of the coping strategies utilized by students to mitigate these pressures.\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cp\u003e2.1 \u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA descriptive, cross-sectional institutional-based study was conducted among final-year medical students at the Faculty of Medicine, University of Dongola, Sudan, during the 2024-2025 academic session.\u003c/p\u003e\n\u003cp\u003e2.2 \u003cstrong\u003ePopulation and Sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population consisted of all final-year medical students. A total of 100 students were recruited using a convenient sampling technique. Inclusion criteria included all students currently registered in their final year who consented to participate. Students who were absent during the data collection period or declined participation were excluded.\u003c/p\u003e\n\u003cp\u003e2.3 \u003cstrong\u003eData Collection Tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected using a self-administered, structured questionnaire consisting of three parts:\u003c/p\u003e\n\u003cp\u003eSocio-demographics: Age, gender, and residency.\u003c/p\u003e\n\u003cp\u003ePerceived Stress Scale (PSS-10): A validated 10-item instrument used to measure the degree to which situations in one\u0026rsquo;s life are appraised as stressful. Items were scored on a 5-point Likert scale (0 = Never to 4 = Very Often). Total scores range from 0 to 40, with scores categorized as low (0\u0026ndash;13), moderate (14\u0026ndash;26), or high (27\u0026ndash;40) stress.\u003c/p\u003e\n\u003cp\u003eStressors and Coping Checklist: A custom list of academic (e.g., exams, workload) and non-academic (e.g., finances) stressors, alongside common coping mechanisms.\u003c/p\u003e\n\u003cp\u003e2.4 \u003cstrong\u003eTheoretical Framework\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study utilized the Yerkes-Dodson Law as a conceptual framework to interpret the relationship between academic pressure and student performance. This model posits that while moderate stress can be beneficial (eustress), excessive pressure leads to a decline in performance and psychological distress.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Statistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using SPSS version [Insert Version, e.g., 26.0]. Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize the data. The Chi-square ($\\chi^2$) test was employed to determine associations between categorical variables (stressors/coping) and stress levels. The Phi ($\\Phi$) coefficient was used to measure the effect size of these associations. A p-value of \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.6 Ethical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures involving human participants were performed in accordance with institutional guidelines and the Declaration of Helsinki.Ethical approval was obtained from the Ethical Committee of the Faculty of Medicine, University of Dongola (Approval Number: p/1/2025). All participants were provided with a clear explanation of the study\u0026rsquo;s purpose, the voluntary nature of their participation, and their right to withdraw at any time without penalty. Informed written consent was obtained from each student before data collection. To ensure confidentiality and anonymity, no identifying information (such as names or ID numbers) was collected, and all data were stored in a password-protected digital format accessible only to the primary researchers.\u003c/p\u003e\n\u003cp\u003e2.7 \u003cstrong\u003eInclusion and Exclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e2.7.1 Inclusion Criteria\u003c/p\u003e\n\u003cp\u003eStudents officially registered in the final year (6th year) of the MBBS program at the University of Dongola.\u003c/p\u003e\n\u003cp\u003eStudents present on campus during the data collection period.\u003c/p\u003e\n\u003cp\u003eStudents who voluntarily provided informed consent to participate.\u003c/p\u003e\n\u003cp\u003e2.7.2 Exclusion Criteria\u003c/p\u003e\n\u003cp\u003eStudents in earlier years of medical training (Years 1\u0026ndash;5).\u003c/p\u003e\n\u003cp\u003eStudents on official leave or those who were absent due to illness during the study period.\u003c/p\u003e\n\u003cp\u003eIncomplete questionnaires (missing \u0026gt;20% of the PSS-10 responses).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eSocio-demographic Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 4.1.1 summarizes the socio-demographic characteristics of the study population, consisting of 100 final-year medical students at University of Dongola, Dongola, NS, Sudan. Most participants were female (77.0%, n=77) while males constituted 23.0% (n=23). The majority of students were aged between 20 and 25 years (82.0%, n=82), and the remainder were aged 26\u0026ndash;30 years (18.0%, n=18).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived Stress, Sources, and Coping Strategies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 4.2.1 presents a comprehensive descriptive analysis summary of PSS statements. Regarding the feeling upset by unexpected events, the distribution shows considerable variability, with nearly half (45.0%) reporting this occurred \u0026ldquo;sometimes\u0026rdquo; and a smaller group (29.0%) experiencing it \u0026ldquo;fairly often.\u0026rdquo; Notably, 9.0% indicated that they were \u0026ldquo;very often\u0026rdquo; upset by unexpected events.\u003c/p\u003e\n\u003cp\u003eWhen asked about controlling important things in life (item 2), 44.0% experienced difficulties \u0026ldquo;sometimes,\u0026rdquo; and 22.0% \u0026ldquo;fairly often.\u0026rdquo; However, almost one-quarter (23.0%) did \u0026ldquo;never\u0026rdquo; feel unable to control these aspects.\u003c/p\u003e\n\u003cp\u003eConcerning \u0026nbsp;the statement \u0026ldquo;feeling nervous or stressed\u0026rsquo;, it revealed that 45.0% claimed they were \u0026ldquo;not at all\u0026rdquo; nervous or stressed over the last month, although 40.0% (combined) acknowledged \u0026ldquo;fairly often\u0026rdquo; or \u0026ldquo;very often\u0026rdquo; stress.\u003c/p\u003e\n\u003cp\u003eConversely, the statement \u0026lsquo;confidence in handling personal problems\u0026rsquo; had 57.0% answering \u0026ldquo;fairly often\u0026rdquo; or \u0026ldquo;very often,\u0026rdquo; indicating the majority felt at least somewhat capable of managing challenges.\u003c/p\u003e\n\u003cp\u003eThe sense of well-being similarly skewed positive, with 45.0% and 35.0% respectively selecting \u0026ldquo;sometimes\u0026rdquo; and \u0026ldquo;fairly often\u0026rdquo; for the perception that things were going their way. Yet, 10.0% rarely felt in control.\u003c/p\u003e\n\u003cp\u003eIn terms of coping capacity (item 6), 43.0% \u0026ldquo;sometimes\u0026rdquo; felt unable to cope, with 23.0% reporting \u0026ldquo;fairly often\u0026rdquo; or \u0026ldquo;very often\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eIrritability control also revealed notable resilience: 45.0% and 36.0% of respondents, respectively, demonstrated confidence by stating \u0026ldquo;fairly often\u0026rdquo; or \u0026ldquo;very often.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eAnger driven by uncontrollable events \u0026nbsp;was reported \u0026ldquo;sometimes\u0026rdquo; or \u0026ldquo;fairly often\u0026rdquo; for 64.0% of respondents. In addition, 47.0% faced difficulties piling up too high \u0026ldquo;sometimes\u0026rdquo; or \u0026ldquo;fairly often,\u0026rdquo; and 8.0% \u0026ldquo;very often\u0026rdquo;. \u0026mdash;signifying commonality of workload stress.\u003c/p\u003e\n\u003cp\u003eThe overall PSS score showed a near-normal pattern with a mean (SD) score of 18.17\u0026plusmn;6.56 (Figure 4.2.1). \u0026nbsp;Regarding the stress status stratification,; 23.0% exhibited low or no stress, 67.0% were categorized as moderate stress, and 10.0% reported high stress levels (Figure 4.2.2).\u003c/p\u003e\n\u003cp\u003eConcerning sources of academic stress (Table 4.2.2), exam pressure was the most frequently reported stressor (73.0%, n=73), followed by academic workload (61.0%, n=61) and uncertainty about career future (36.0%, n=36). Financial problems affected 32.0% (n=32), while difficulties with social relationships (24.0%, n=24) and health issues (10.0%, n=10) were less common. A high proportion of participants (86.0%, n=86) acknowledged that stress negatively affected their academic performance.\u003c/p\u003e\n\u003cp\u003eStudents reported employing various coping strategies: meditation or prayer (67.0%, n=67), sleeping or resting (51.0%, n=51), talking to friends or family (46.0%, n=46), and physical exercise (17.0%, n=17) were most common. Less frequently, students used stimulants like smoking/tobacco (11.0%, n=11), ignored the problem (11.0%, n=11), ate more (15.0%, n=15), or sought professional help (2.0%, n=2). Most perceived their coping method as effective (82.0%, n=82), and two-thirds (67.0%, n=67) expressed desire for formal psychological support or training.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImpact of Academic Stress Sources on Perceived Stress\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnalysis of associations between sources of academic stress and perceived stress levels is presented in Table 4.3.1. The strongest and most statistically significant positive associations was exam pressure, with 87.7% of students who reported experiencing exam pressure categorized in the moderate or high stress group, compared to only 48.1% among those without exam pressure. This association was statistically significant (\u0026chi;\u0026sup2; = 17.39, df = 1, p \u0026lt; 0.001), and the corresponding effect size (Phi = 0.417) indicated a large magnitude of association.\u003c/p\u003e\n\u003cp\u003eAcademic workload also demonstrated a significant positive relationship with perceived stress. Among students citing academic workload as a stressor, 85.2% were found in the moderate or high stress group, compared to 64.1% of those who did not identify workload as a stressor (\u0026chi;\u0026sup2; = 6.01, df = 1, p = 0.014)., with a moderate effect size (Phi = 0.245).\u003c/p\u003e\n\u003cp\u003eBy contrast, sources such as financial problems, uncertainty about career future, social relationship difficulties, and health issues did not demonstrate statistically significant associations with perceived stress level in this sample (all p \u0026gt; 0.05, Phi \u0026lt; 0.2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImpact of Coping Strategies on Perceived Stress\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe impact of various coping strategies on perceived stress levels among final-year medical students is summarized in Table 4.4.1. Physical exercise was found to have a statistically significant association with lower levels of perceived stress: 58.8% of those who practiced physical exercise fell into the low or no stress group, compared to only 15.7% among students who did not use this strategy (\u0026chi;\u0026sup2; = 14.84, df = 1, p \u0026lt; 0.001), with a large effect size (Phi = -0.385).\u003c/p\u003e\n\u003cp\u003eSimilarly, talking to friends or family demonstrated a significant and substantial impact. Of the students who engaged in this coping method, 39.1% reported low or no stress, contrasting with only 9.3% of those who did not talk to friends or family (\u0026chi;\u0026sup2; = 12.52, df = 1, p \u0026lt; 0.001, Phi = -0.354).\u003c/p\u003e\n\u003cp\u003eOther coping strategies\u0026mdash;including sleeping or resting, meditation or prayer, use of stimulants (smoking, tobacco), ignoring the problem, eating, and seeking professional help\u0026mdash;were not significantly associated with stress level (all p \u0026gt; 0.05; Phi effect sizes range from -0.013 to 0.192, all small to negligible).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the levels, sources, and coping strategies of stress among final-year medical students at the University of Dongola. The findings revealed that 67% of respondents experienced moderate stress, 10% high stress, and only 23% low or no stress. These results confirm that medical education remains psychologically demanding and emotionally taxing, as documented globally.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived Stress and Comparative Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean perceived stress score ($18.17 \\pm 6.56$) observed in this study is consistent with the moderate range reported across medical schools in Sudan and internationally. At the University of Gezira, 72.9% of medical students experienced moderate stress and 16.1% severe stress (Elsharief, 2023). Likewise, Ragab et al. (2021) found that Sudanese medical students across six universities faced intense pressure due to workload, time constraints, and fear of failure.\u003c/p\u003e\n\u003cp\u003eComparable findings were reported elsewhere in the region and beyond: in Pakistan, over half of the respondents exhibited psychological distress (Imran et al., 2016); in India, academic workload and fear of failure were major contributors (Anuradha et al., 2017); and in Bangladesh, 68.6% of final-year medical students displayed stress symptoms (Alam et al., 2025). In Saudi Arabia, several studies recorded stress prevalence rates between 59% and 82% among medical students (Bamuhair et al., 2015; Gazzaz et al., 2018; Salih et al., 2023), while in Nepal, over half of students reported being stressed (Paudel et al., 2024). These findings align with the results from Dongola and affirm that medical students worldwide experience high stress regardless of differences in curriculum or socioeconomic setting. While historical models like the Yerkes-Dodson Law suggest that moderate pressure can enhance habit-formation and alertness, the high prevalence of moderate-to-severe stress found in this study (77%) indicates that final-year students at Dongola have likely surpassed their peak performance threshold, entering a state of psychological distress that requires institutional support.\u003c/p\u003e\n\u003cp\u003eOne notable finding from the current study was that most students felt \u0026ldquo;sometimes\u0026rdquo; or \u0026ldquo;fairly often\u0026rdquo; upset or unable to cope with the demands of their studies. However, the majority also reported confidence in handling personal problems, which indicates a degree of resilience. Such duality\u0026mdash;high stress yet functional coping\u0026mdash;is common among medical trainees, as seen in previous work from Brazil and Syria (Al Houri et al., 2023; Murakami et al., 2025), where students maintained acceptable academic performance despite ongoing psychological strain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSources of Academic Stress\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExam pressure and academic workload were the dominant sources of stress, affecting 73% and 61% of participants, respectively. This aligns with previous Sudanese research identifying similar stressors (Ragab et al., 2021; Elsharief, 2023). Academic overload has also been repeatedly cited as a key source of stress in Saudi Arabia (Bamuhair et al., 2015; Gazzaz et al., 2018; Salih et al., 2023) and India (Anuradha et al., 2017), where students often report anxiety about performance, insufficient rest, and limited recreational time.\u003c/p\u003e\n\u003cp\u003eThe statistical analyses in this study confirmed significant associations between exam pressure ($\\chi^2 = 17.39, p \u0026lt; 0.001, \\text{Phi} = 0.417$) and workload ($\\chi^2 = 6.01, p = 0.014, \\text{Phi} = 0.245$) with higher perceived stress levels. These results echo the findings of Gazzaz et al. (2018), who reported that academic stress was significantly correlated with academic performance ($p \u0026lt; 0.05$). In Vietnam, Nguyen et al. (2024) observed that concerns about future competence and academic success were major determinants of stress intensity.\u003c/p\u003e\n\u003cp\u003eIn contrast, non-academic stressors such as financial problems, health issues, and social difficulties showed no statistically significant association with perceived stress. This pattern has been noted previously in Brazil (Murakami et al., 2025), suggesting that academic factors dominate the emotional landscape of medical students, often eclipsing other stress domains.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCoping Strategies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents at Dongola employed various coping strategies, with prayer or meditation (67%), sleeping or resting (51%), and social interaction (46%) being the most common. These coping styles are consistent with patterns in Islamic cultural contexts, where religious practices serve as a primary coping mechanism (Bamuhair et al., 2015; Salih et al., 2023). The preference for emotional and religious coping over problem-focused approaches mirrors findings from Saudi Arabia and Nepal (Bamuhair et al., 2015; Paudel et al., 2024).\u003c/p\u003e\n\u003cp\u003eSignificant negative associations were observed between stress levels and both physical exercise ($\\chi^2 = 14.84, p \u0026lt; 0.001, \\text{Phi} = -0.385$) and talking to friends or family ($\\chi^2 = 12.52, p \u0026lt; 0.001, \\text{Phi} = -0.354$), indicating their protective effect. Similar results have been reported in studies from Pakistan (Imran et al., 2016) and Vietnam (Nguyen et al., 2024), where social support and active coping strategies mitigated stress. Encouragingly, the majority (82%) perceived their coping mechanisms as effective, yet 67% expressed a desire for structured psychological support\u0026mdash;highlighting the unmet need for formal counseling services.\u003c/p\u003e\n\u003cp\u003eNotably, maladaptive strategies such as substance use, avoidance, and overeating were relatively uncommon ($\u0026lt;15\\%$), unlike in some Western settings (Graves et al., 2021), suggesting a more conservative and socially moderated coping culture among Sudanese students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGender Differences\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough gender-specific data were not the primary focus of this study, the predominance of female participants (77%) warrants mention. Previous studies consistently show that female medical students report higher perceived stress and employ more emotion-focused coping strategies (Bamuhair et al., 2015; Graves et al., 2021; Fasoro et al., 2019; Mahlangu et al., 2024). The overrepresentation of women in this sample may partially explain the high prevalence of moderate stress observed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings underscore the need for institutional interventions aimed at reducing academic stress and promoting student well-being. Universities should integrate stress management workshops, academic advising systems, and peer mentoring programs into the medical curriculum. Promoting physical activity, social connectedness, and open communication can enhance resilience. Additionally, incorporating counseling and psychological support services would address the gap in professional mental health access noted among participants.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFinal-year medical students at the University of Dongola experience significant psychological pressure, with 77% reporting moderate-to-high stress levels. While academic stressors\u0026mdash;specifically exam pressure and heavy workloads\u0026mdash;are the primary drivers of this distress, students demonstrate a cultural reliance on religious coping and social support.\u003c/p\u003e \u003cp\u003eWhile historical models like the Yerkes-Dodson Law suggest that moderate pressure can enhance habit-formation and alertness, the high prevalence of distress found in this study indicates that these students have surpassed their peak performance threshold. Without institutional intervention, this level of chronic stress risks compromising not only the students' mental health but also the quality of patient care they will provide as future clinicians.\u003c/p\u003e \u003cp\u003e \u003cb\u003eRecommendation\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eReview the examination schedule to prevent the \"clustering\" of high-stakes tests, which students identified as their primary source of stress.\u003c/p\u003e \u003cp\u003eEstablish a confidential counseling unit on campus to provide professional mental health support specifically for medical students.\u003c/p\u003e \u003cp\u003eIntegrate stress management workshops into the curriculum to teach students time management, mindfulness, and healthy coping mechanisms.\u003c/p\u003e \u003cp\u003eImprove access to recreational and sports facilities, as your data proved that physical exercise significantly reduces perceived stress levels (\u003cspan\u003e$\u003c/span\u003e\\chi^2\u0026thinsp;=\u0026thinsp;14.84\u003cspan\u003e$\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eImplement a faculty-student mentorship program to help final-year students navigate the transition between academic study and clinical responsibility.\u003c/p\u003e \u003cp\u003ePromote social connectedness through student-led wellness committees, acknowledging that talking to friends and family acts as a vital protective factor.\u003c/p\u003e \u003cp\u003e Foster a culture of \"professional readiness\" by providing clearer clinical guidelines, reducing the anxiety associated with \"unclear assignments.\"\u003c/p\u003e \u003cp\u003eDevelop a national framework for student wellness in collaboration with other Sudanese medical schools to standardize mental health support across the region.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis study has several limitations that should be considered when interpreting the results. First, the cross-sectional design provides a snapshot of stress at a single point in time, which prevents the establishment of a causal relationship between specific stressors and long-term psychological outcomes. Second, the reliance on self-reported data may introduce social desirability bias, where students might underreport maladaptive coping behaviors (such as substance use) or overreport positive ones (such as prayer).\u003c/p\u003e \u003cp\u003eThird, the study was conducted at a single institution, the University of Dongola, meaning the findings may not be fully generalizable to medical students in other regions of Sudan or different educational contexts. Finally, while the Yerkes-Dodson Law provides a theoretical framework for the findings, this study did not objectively measure academic performance (e.g., GPA or exam scores) to correlate it directly with stress levels.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the Faculty of Medicine, University of Dongola (Reference No: P/1/2025) Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eKamal A. A. Mohammed designed the study, performed the statistical analysis and drafted the manuscript.\u003c/p\u003e\n\u003cp\u003eRowaa G. A. Ahmed and Anfal A. O. Ibrahim\u003c/p\u003e\n\u003cp\u003eCollected data, wrote the initial draft. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the students of the University of Dongola for their participation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAl Houri, H.N., Jomaa, S., Arrouk, D.M.N., et al. (2023) \u0026apos;The prevalence of stress among medical students in Syria and its association with social support: a cross-sectional study\u0026apos;, BMC Psychiatry, 23(1), p. 97.\u003c/li\u003e\n \u003cli\u003eAlam, M.J., Pratik, M.I.K., Khan, A.H., et al. (2025) \u0026apos;Prevalence and level of stress among final-year students at a health science institute in Bangladesh\u0026apos;, Discovery Mental Health, 5(1), p. 9.\u003c/li\u003e\n \u003cli\u003eAnuradha, R., Dutta, R., Raja, J.D., et al. (2017) \u0026apos;Stress and stressors among medical undergraduate students: a cross-sectional study in a private medical college in Tamil Nadu\u0026apos;, Indian Journal of Community Medicine, 42(4), pp. 222\u0026ndash;225.\u003c/li\u003e\n \u003cli\u003eBamuhair, S.S., Al Farhan, A.I., Althubaiti, A., et al. (2015) \u0026apos;Sources of stress and coping strategies among undergraduate medical students enrolled in a problem-based learning curriculum\u0026apos;, Journal of Biomedical Education, 2015, pp. 1\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eDyrbye, L.N., Thomas, M.R. and Shanafelt, T.D. 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(2016) \u0026apos;Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis\u0026apos;, JAMA, 316(21), pp. 2214\u0026ndash;2236.\u003c/li\u003e\n \u003cli\u003eSalih, S., Mahmoud, S.S., Abudeyah, M.A., et al. (2023) \u0026apos;Stressors and coping strategies among medical students in Jazan, Saudi Arabia: a cross-sectional study\u0026apos;, Journal of Family Medicine and Primary Care, 12(9), pp. 2075\u0026ndash;2081.\u003c/li\u003e\n \u003cli\u003eSreeramareddy, C.T., Shankar, P.R., Binu, V.S., et al. (2007) \u0026apos;Psychological morbidity, sources of stress and coping strategies among undergraduate medical students of Nepal\u0026apos;, BMC Medical Education, 7(1), p. 26.\u003c/li\u003e\n \u003cli\u003eSteptoe, A. and Wardle, J. (2001) \u0026apos;Health behaviour, stress and well-being\u0026apos;, British Journal of Health Psychology, 6(2), pp. 113-115.\u003c/li\u003e\n \u003cli\u003eTam, W., Lo, K. and Pacheco, J. (2019) \u0026apos;Prevalence of depressive symptoms and suicidal ideation among medical students: a systematic review and meta-analysis\u0026apos;, Journal of Affective Disorders, 252, pp. 315-325.\u003c/li\u003e\n \u003cli\u003eYerkes, R.M. and Dodson, J.D. (1908) \u0026apos;The relation of strength of stimulus to rapidity of habit-formation\u0026apos;, Journal of Comparative Neurology and Psychology, 18(5), pp. 459-482.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 4.1.1: Socio-demographic Characteristics of Final-Year Medical students at University of Dongola, Dongola, NS, Sudan, 2025 (n=100)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"546\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e23.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e77.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003e20-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e82.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003e26\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4..2.1: Frequency Distribution of Perceived Stress Scale Responses among Final-Year Medical students at University of Dongola, Dongola, NS, Sudan, 2025 (n=100)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"546\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePSS Statement Summary\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOptions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0 (N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 (AN)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2 (S)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 (FO)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 (VO)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003eUpset by unexpected events\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e3 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e14 (14.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e45 (45.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e29 (29.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e09 (9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003eUnable to control important things\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e23 (23.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e5 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e44 (44.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e22 (22.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e06 (6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003eFelt nervous or stressed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e45 (45.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e14 (14.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e01 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e29 (29.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e11 (11.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003eConfident about handling personal problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e05 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e28 (28.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e45 (45.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e12 (12.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003eFelt things were going your way\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e03 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e8 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e44 (44.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e35 (35.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003eCould not cope with all you had to do\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e12 (12.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e22 (22.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e43 (43.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e14 (14.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e9 (9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003eAble to control irritations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e6 (6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e15 (15.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e41 (41.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e27 (27.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e11 (11.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003eFelt on top of things\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e03 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e18 (18.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e43 (43.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e28 (28.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e8 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003eAngered by things outside control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e03 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e21 (21.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e42 (42.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e22 (22.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e12 (12.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003eDifficulties piling up too high\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e10 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e26 (26.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e39 (39.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e17 (17.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e08 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4..2.2: Frequency Distribution of Sources of Academic Stress, Stress Effects, and Coping Strategies among Final-Year Medical Students at University of Dongola, Dongola, NS, Sudan, 2025 (n=100)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"546\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSources of academic stress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eFinancial problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e32.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eExam pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e73.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eAcademic workload\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e61.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eUncertainty about career future\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e36.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eSocial relationships\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e24.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eHealth issues\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStress effects academic performance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e86.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCoping strategies during stress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003ePhysical exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e17.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eTalking to friends or family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e46.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eSleeping or resting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e51.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eMeditation or prayer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e67.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eUse of stimulants (smoking, tobacco)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eIgnoring the problem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eEating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eSeeking help from mental health professional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived effectiveness of coping method\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eEffective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e82.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eNot effective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDesire for psychological support or training\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e67.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 402px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e33.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.3.1: Association of Sources of Academic Stress with Perceived Stress Levels among Final-Year Medical Students at University of Dongola, Dongola, NS, Sudan, 2025 (n=100)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"546\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSource of Academic Stress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived Stress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026chi;\u0026sup2; (df)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhi\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo or Low Stress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate or High Stress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFinancial Problems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e6 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e26 (81.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.48 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.488\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e17 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e51 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExam Pressure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e9 (12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e64 (87.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e17.39 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.417\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e14 (51.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e13 (48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcademic Workload\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e9 (14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e52 (85.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e6.01 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.245\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e14 (35.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e25 (64.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUncertainty about Career Future\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e10 (27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e26 (72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.73 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e13 (20.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e51 (79.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial Relationships\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e3 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e21 (87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1.97 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e20 (26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e56 (73.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth Issues\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e10 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e3.32 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e23 (25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e67 (74.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.4.1: Association of Coping Strategies of Academic Stress with Perceived Stress Levels among Final-Year Medical Students at University of Dongola, Dongola, NS, Sudan, 2025 (n=100)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"546\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCoping Strategies of Academic Stress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived Stress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026chi;\u0026sup2; (df)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhi\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo or Low Stress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate or High Stress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical exercise\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e10 (58.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e7 (41.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e14.84 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.385\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e13 (15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e70 (84.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTalking to friends or family\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e18 (39.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e28 (60.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e12.52 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.354\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e5 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e49 (90.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleeping or resting\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e12 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e39 (76.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.02 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.898\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e11 (22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e38 (77.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeditation or prayer\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e15 (22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e52 (77.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.04 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.836\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e8 (24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e25 (75.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse of stimulants (smoking, tobacco)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e2 (18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e9 (81.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.16 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e21 (23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e68 (76.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIgnoring the problem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e11 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e3.69 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e23 (25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e66 (74.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEating\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e4 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e11 (73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.13 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e19 (22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e66 (77.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeeking help from mental health professional\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e1 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e1 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.84 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e22 (22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e76 (77.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Academic Stress, Coping Strategies, Medical Students, Sudan, Yerkes-Dodson Law","lastPublishedDoi":"10.21203/rs.3.rs-8881115/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8881115/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMedical education is globally recognized as a high-stress environment, yet localized data on final-year students in Northern Sudan remains scarce. This study investigated the prevalence, sources, and coping mechanisms of stress among final-year medical students at the University of Dongola.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted using the Perceived Stress Scale (PSS-10) and a structured questionnaire to identify academic and non-academic stressors. Statistical associations were analyzed using Chi-square (\u003cspan\u003e$\u003c/span\u003e\\chi^2\u003cspan\u003e$\u003c/span\u003e) and Phi (\u003cspan\u003e$\u003c/span\u003e\\Phi\u003cspan\u003e$\u003c/span\u003e) tests.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe findings revealed that 77% of respondents experienced moderate-to-high stress levels (67% moderate; 10% high), with a mean PSS score of \u003cspan\u003e$\u003c/span\u003e18.17 \\pm 6.56\u003cspan\u003e$\u003c/span\u003e. Exam pressure (73%) and academic workload (61%) were the dominant stressors. Significant associations were found between high stress and exam pressure (\u003cspan\u003e$\u003c/span\u003e\\chi^2\u0026thinsp;=\u0026thinsp;17.39, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003cspan\u003e$\u003c/span\u003e) and workload (\u003cspan\u003e$\u003c/span\u003e\\chi^2\u0026thinsp;=\u0026thinsp;6.01, p\u0026thinsp;=\u0026thinsp;0.014\u003cspan\u003e$\u003c/span\u003e). Prayer (67%) and social interaction (46%) were the primary coping strategies. Physical exercise and social support showed significant protective effects against high stress levels (\u003cspan\u003e$\u003c/span\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003cspan\u003e$\u003c/span\u003e).\u003c/p\u003e\u003ch2\u003eDiscussion\u003c/h2\u003e \u003cp\u003eWhile the Yerkes-Dodson Law suggests that moderate pressure can enhance performance, the 77% prevalence rate indicates that students have surpassed their \"peak\" threshold and entered a state of distress.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAcademic factors, rather than personal or financial issues, dominate the stress profile of final-year students at Dongola. There is an urgent need for institutionalized mental health support and curriculum reforms to balance academic rigor with student well-being.\u003c/p\u003e","manuscriptTitle":"Prevalence Sources and Coping Strategies of Stress Among Final Year Medical Students at the University of Dongola Sudan During 2025 to 2026 Cross Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-19 16:17:56","doi":"10.21203/rs.3.rs-8881115/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-15T08:37:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-10T10:14:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-01T20:17:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"121612160597482737607727879856957580215","date":"2026-04-01T15:07:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"82425588951724832637049001368765578635","date":"2026-04-01T14:35:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"229974757598156552822704617776231470727","date":"2026-03-30T16:59:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-24T14:08:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"175970280907394787368414241272869618256","date":"2026-03-16T14:44:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-16T12:21:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-04T07:57:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-03T19:59:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Mental Health","date":"2026-03-03T13:20:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ba5cf951-884f-434a-acc5-b6496fa7af6d","owner":[],"postedDate":"March 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T12:24:55+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-19 16:17:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8881115","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8881115","identity":"rs-8881115","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}