Anxiety Disorder Amongst Clinical Medical Students at the University of Nigeria Teaching Hospital, ENUGU CAMPUS: a Comparative Study

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One of the most common presentations is a panic attack, in which students experience attacks that are especially close to tests and examinations due to the cumbersome academic workload. This paper reviews the effect of anxiety disorders among medical students at the University of Nigeria Enugu Campus. An online questionnaire was distributed to the 3 rd , 4 th, and 5 th MBBS classes in an attempt to determine the prevalence and knowledge of anxiety in these classes, and any known coping mechanisms and to perform a comparative study on socio-demographic, academic, and personal factors. The results revealed a preponderance in females and fear of failure and a high dependence on receiving emotional support from family, praying and meditating as coping mechanisms. Hopefully, this study will inform academic authorities on the need to adjust syllables due to increased workload as a contributing factor of anxiety disorder and school authorities on the need for a closed student-lecturer interaction. Psychiatry ANXIETY CLINICAL Figures Figure 1 Figure 2 Figure 3 Introduction Background information Anxiety is a physiologic reaction to triggering events with the end goal of making us rise up to the occasion and get out of certain situations. Anxiety disorders were previously called hypochondria and affect many people older than 18 years; however, they can also affect teenagers. [1] Anxiety disorders, including panic disorder with or without agoraphobia, generalized anxiety disorder, social anxiety disorder, specific phobias, and separation anxiety disorder, are the most prevalent mental disorders and are associated with immense health care costs and a high burden of disease [2] . Of the barrage of Anxiety disorders, Specific phobias are the most common, with a prevalence of 10.3%; panic disorders (with or without agoraphobia) are the next most common, with a prevalence of 6.0%; followed by social phobias (2.7%); and generalized anxiety disorders (2.2%). [3] Medical education is considered to be one of the most academically and emotionally demanding training programs available for any profession, and consequently, the time and emotional commitment necessary for medical students to devote to their training are extensive. Such demands and stress cause a negative effect on students’ psychological well-being, thus, precipitating anxiety disorders. [4] Psychological distress (as can be caused by anxiety disorders) among medical graduates is thought to be associated with suboptimal patient care, patient safety and professionalism [5] , highlighting the massive toll anxiety disorders take on patient care, by extension. Anxiety disorders are the most common mental disorders, affecting approximately 30% of adults during their lifetime [6] , with women being more likely than men to have anxiety symptoms, with a lifetime incidence ratio of 1.7:1 [7] . In the United States, anxiety disorders are the most common mental illness, affecting approximately 40 million adults each year (18.1% of the population). It is highly treatable, yet only 36.9% of patients seek medical aid. [8] Similarly, in Nigeria, anxiety disorders again predominate compared to other mental disorders, with a lifetime prevalence rate of 5.7% and a 12-month prevalence rate of 4.1%, with specific phobias being the most common subtype. [9] If an anxiety disorder is not detected early enough, it may result in a slow recovery and affect or worsen the person’s physical health. Evidence points to comorbidities being associated with anxiety disorders [10] ; therefore, anxiety disorders need to be identified and managed promptly to prevent deterioration in the health of patients. Depression is also associated with significant rates of substance misuse, depressive and manic symptoms, as well as other consequences, such as decreased productivity in study studies with resultant poor academic students’ performance in students with low self-esteem, lack of self-confidence, decreased memory span, lack of concentration and prolonged school years of stay. To the best of our knowledge, there has not been a comparative study on the prevalence and effects of anxiety disorders amongst among clinical medical students at the University of Nigeria, Enugu Campus. Thus, this study was designed to determine the prevalence of anxiety disorders among clinical medical students, the effects of anxiety disorders on their academic performance, the associated factors and the coping strategies adopted by the affected individuals. Health and education are the two cornerstones of human capital and form the basis of an individual’s economic productivity [11] . Anxiety disorders among students is a serious health challenge because they can interfere with these two cornerstones and alter their future potential. Fortunately, studies on the subject are rapidly growing, although disproportionately across regions. Generalization with foreign findings may not be helpful because of differences in the value of health across different countries, health insurance, and living conditions of the students, as well as in the structure of the students’ support systems. Medical students, by virtue of their hectic daily schedules and demanding nature of the course are at increased risk of anxiety disorders; hence, there is a need to properly elucidate its possible causes, varied presentations and institute therapies. Compared to the general population, medical students have greater levels of anxiety. [12] Medical students in Nigeria are prone to a spectrum of anxiety disorders. This susceptibility is influenced by sociodemographic characteristics. [13] These characteristics can include age at school, gender, allowances, relationships with friends or parents, and marital status. This study contributes immeasurably to the literature on anxiety disorders among medical students at the University of Nigeria. This comparative study therefore aimed to fill some of these key research gaps by studying anxiety disorders, thus helping us better understand the clinical features and possible factors associated with anxiety disorders among medical students at the UNIVERSITY OF NIGERIA, ENUGU CAMPUS with an end game of eradicating anxiety disorder through the development of better prevention strategies, treatment programs and rehabilitation packages. General Objectives This study aims aimed to determine the prevalence and associated factors of anxiety amongst disorders among clinical medical students at the University of Nigeria, Enugu campus Specific Objectives To determine the prevalence of anxiety disorders among clinical medical students at the University Of Nigeria, Enugu Campus. To assess personal and socio-demographic sociodemographic factors associated with anxiety disorder disorders among clinical medical students at the University Of Nigeria, Enugu Campus To ascertain the effects of anxiety disorder disorders on the academic and social lives of clinical medical students at the University Of Nigeria, Enugu Campus To compare the prevalence of anxiety disorder disorders among clinical medical students in the University Of Nigeria, Enugu Campus To assess coping strategies for anxiety disorders among clinical medical students at the University Of Nigeria, Enugu Campus. Literature Review Many students perform poorly because of anxiety. This has contributed to their adequate preparation for exams, causing some students to easily forget what they read and preventing them from being unable to produce the information in an appropriate way. Due to these few observations concerning the effect of anxiety, a good study of anxiety among students, particularly clinical medical students, will help in discovering the causes of anxiety disorders and the underlying mechanisms involved. Anxiety disorders are mental health disorders characterized by feelings of worry or fear that are strong enough to interfere with one’s activity. Previous studies examining anxiety disorder separately are rare despite the noted effect of anxiety on the academic performance of medical students, on the generation of poor coping strategies such as the use of alcohol and nicotine, and on the development of long-term effects on their performance as doctors in terms of poor work efficacy. Anxiety disorders, as a topic, have been neglected, and there is limited research on anxiety. There is a knowledge gap on anxiety disorders in the developing population at large and, unfortunately, among medical students in Nigeria despite the psychopathological effect of these disorders. Therefore, this study will contribute greatly to enlightening the public at large on the increasing burden of anxiety disorders among people, particularly medical students, and thus lead to the development of policies, such as the formation of a student-friendly environment and the development of counseling services and various forms of psychological therapy, that will help in curbing the prevalence of anxiety disorders among medical students. There is no known objective way to measure the level of difficulty a university course presents; however, there is widespread agreement that some courses are more difficult than most and that medicine and surgery as a course is constantly thought to be among the top 10 when ranked according to the level of difficulty and intensity of challenge. Medical students experience high levels of stress and anxiety (more so than do the general population), possibly because they have voluminous materials to memorize, sleep deprivation, social isolation, and so forth. In addition, many medical schools are structured to foster competition rather than cooperation, resulting in the aggravation of present stress. [1] In a meta-analysis intended to determine the global prevalence of anxiety among medical students performed by Travis Tian-Ci Quek et al. in 2019, a total of sixty-nine studies were pooled and analyzed. The studies included 40,438 medical students. Eighteen studies were from Asia, twenty-one from the Middle East, thirteen from Europe, ten from South America, four from North America, two from Oceania and one from Africa. The sample sizes of the studies ranged from 73 to 10,140, and screening instruments such as BAS 21, DASS 21, HADS and GAD 7 were utilized to assess the presence of anxiety disorders in medical students. The mean age of the individuals ranged from 18.02 years to 25.10 years. This meta-analysis revealed that the average prevalence of NAFLD among the total number of studies pooled was 35.4%. When the prevalence was stratified by sex, we found that female medical students had a greater incidence of anxiety (38.0%) than male students did (27.6%), but this difference was not statistically significant (p = 0.16). It was suggested that destigmatization of mental illness and the culture of help-seeking behavior should start from the school’s administration, which includes making rules that would favor an increase in the help-seeking behavior of those with mental illness. [4] In another study by Naomi A. Dike-Israel et al.on the prevalence and comorbidity of depression and anxiety among medical students at Babcock University, Ogun State, Nigeria, a cross-sectional survey was conducted with undergraduate medical students who were recruited randomly from classes. The sample included 225 medical students (68.8% women and 30.2% men), with a mean age of 19.09 years (±2.14 S.D.). An online survey utilizing the Beck Anxiety Inventory (BAI) was administered to make a provisional diagnosis of anxiety and its severity. The results indicated a 28.4% prevalence of anxiety among the respondents. The study determined that the year of study with the highest prevalence of anxiety and depression was year 3, and the year of study with the lowest prevalence was year 6. From this study, suggestions such as the creation of sensitization programs for mental disorders, the provision of mandatory counseling services for students at least once in every academic session and the provision of help-lines for students who would like to be anonymous were made by the people who did this study with the aim of reducing the prevalence of anxiety and depression, which is also a comorbidity and thus the long-term effects of these mental disorders. One limitation of this study is that it focused only on one institution. [13] A.O. Coker et al. studied the “sociodemographic correlates and symptoms of depression, anxiety and stress among a sample of Nigerian medical students.’’ This was a cross-sectional descriptive study of 240 medical students in the 2 nd to 6 th academic years of study. The Depression Anxiety Stress Scale 21 (DASS-21) was analyzed using the International Business Machine Statistical Package for the Social Science version 18 (IBM-SPSS). Unlike previous studies that showed a high prevalence of these disorders, this study showed a low prevalence of depression and anxiety, which was attributed to the close proximity of the students’ hostel to the college and the friendly atmosphere of the school. According to the sociodemographic relationship with the incidence of NAFLD, individuals aged 23-28 years experienced more depression, anxiety and stress than did those aged 29-34 years. Male participants experienced more depression and anxiety than female participants did, although female students were known to be more stressed. In this study, it was also noted that some students resorted to poor coping habits. The limitation of this study was the use of a homogenous sample of medical students from one university. [14] Anita H Laidlaw studied social anxiety at the University of St Andrews in 2009 among a total of 247 medical students, 60% of whom were female. The students completed a questionnaire survey measuring levels of social anxiety and attitudes toward communication skills teaching. A total of 300 medical students were included, 247 of whom completed the questionnaire (82% response rate). The questionnaire included the social phobia scale, social interaction anxiety scale, reduced version of the Communication Skills Attitude Scale and several demographic questions. In comparison with that of the other subgroups, the prevalence of social anxiety was lower among medical students. Compared with their male counterparts, female students had a greater level of social anxiety. One of the studies the author examined noted that adolescents suffering from high levels of social anxiety may be less likely to achieve the grades to enable them to apply for medical school. The study revealed that social anxiety contributes to a negative attitude toward teaching communication skills and may impact participation in group workshops. The impact of social anxiety on the ability of students to communicate with potential patients during practical examinations was not examined in this study. The author also noted that social anxiety was positively correlated with alcohol dependence and problems caused by alcohol. [15] Methodology STUDY AREA The study was carried out at the University of Nigeria, the Enugu Campus, and the Ituku Ozalla campus as well as at the University of Nigeria Teaching Hospital, Old Site, Enugu. STUDY POPULATION Undergraduate clinical medical students at the University of Nigeria, Enugu Campus. There are different hostels for the different classes of clinical medical students. The clinical medical students in the University of Nigeria Teaching Hospital Ituku and Oldsite, and the clinical students in the University of Nigeria Enugu Campus participated STUDY DESIGN The study design was a cross-sectional epidemiological study of the descriptive type among Clinical medical students at the University of Nigeria Teaching Hospital, Enugu. INCLUSION CRITERIA All the clinical medical students were from the University of Nigeria, Nsukka. The sample included 4 th , 5 th, and 6 th year medical students. It also included the senior 3 rd year medical students who just started their clinical program EXCLUSION CRITERIA UNEC students from other faculties Preclinical students at the Nsukka and Enugu campuses Preclinical and Clinical students who were not available during our data collection SAMPLING METHOD The sample size was calculated using the Cochrane sample size formula Minimum sample size, n = Z 2 p(1-p)/d 2 where Z = 1.96 at the 95% confidence limit P = Prevalence of anxiety disorder from a previous study (28.4%) d = Margin of error tolerated, usually 5% (or 0.05) N = 1.96 2 × 0.284 (1-0.284) (0.05) 2 =312.467 students The addition of 10% to compensate for attrition will increase the sample size too 10% of 312.467 = 31.2467 Minimum Sample Size = 312.467 + 31.2467 = 343.7137 Approximately 344 students probability sampling via the simple random sampling technique was used. . DATA COLLECTION This study was performed by collecting primary data via a self-administered online questionnaire, which was completed by the respondents. The questionnaire was pretested at Enugu State University Teaching Hospital Parklane It had eight sections that assessed the following SECTION A: Personal and Sociodemographic Data SECTION B: Parental Demographic Data SECTION C: Level of awareness of anxiety disorders SECTION D: Assessment of prevalence of anxiety disorder using the Beck’s Anxiety Inventory (1988) with a modified time frame assessing for presence of anxiety symptoms since 2 nd MBBS. The instrument consists of 21 items that are answered using a multiple choice scale. Each item has a score of 0–3, with higher scores indicating more severe symptoms. The inventory divides the scores into low (minimal and mild), moderate and severe anxiety. Scores ranged from 0-21 for mild anxiety, 22-35 for moderate anxiety and 36-63 for severe anxiety. The BAI measures emotional, cognitive and physiological symptoms of anxiety. SECTION E: Assessment of coping strategies SECTION F: Effects of anxiety disorders on the Academic Life of Clinical Students SECTION G: Effects of anxiety disorders on the Social Life of Clinical Students SECTION H: Factors associated with anxiety Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 26.0. The data are presented in the tables. Ethical approval was obtained prior to the field work from the Department of Community Medicine UNTH as well as the Student Affairs Department UNN, Enugu and Ituku Ozalla Campuses. The respondents’ data were carefully handled. Results Response rate and characteristics of participants (Tables 1 and 2) Of the 1265 clinical medical students enrolled at the University of Nigeria Teaching Hospital, Enugu,342 (27%) participated in the research. A total of 224 (65.5%) of them were aged between 21 and 25 years, while 75 (21.9%) were aged between 16 and 20 years. The rest were older than 25 years. The mean age of the participants was 22.59 ±2.67 years. There was almost equal gender representation, with 172 females (50.3%) and 170 males (49.7%). The year of study of the respondents was distributed as follows: 28.7% in 300 L, 21.3% in 400 L, and 22.2% in 500 L; 27.8% in 600 L. In this study, 57.6% had monthly incomes greater than 20,000 naira, 98% were unmarried, and 83.9% had their parents married still. When asked about their awareness of anxiety, 97.4% had heard about anxiety, with approximately 60.2% hearing about it in the mass media. The respondents were asked to self-rate their anxiety levels, and 27.5% admitted that they were overly anxious. Approximately 78.7% of respondents thought people with anxiety disorders should be counseled as against being ignored or given medications. A majority (86%) believe that anxiety can be cured. Prevalence of anxiety symptoms among medical students (Table 4) When the BAI (with adjusted time range) was self-administered, moderate anxiety symptoms were prevalent in 26.6% of the students, and 21.9% of the students had severe anxiety according to the scoring of the 1988 version of the BAI. Considering the scoring of the 1992 BAI, moderate and severe symptoms had incidences of 21.6% and 40.6%, respectively. Associations between student characteristics (Tables 5 and 6) This study revealed that anxiety was significantly associated with sex (p=0.001, x 2 =13.77) , fear of failure of professional exams (p≤0.05, x 2 =22.5) , sleepless nights (p=0.002, x 2 =28.47) , parental pressure (p≤0.05, x 2 =22.08) , fear of fellow students (p≤0.05, x 2 =13.13) , academic stress (p=0.02, x 2 =8.16) and overdemanding lecturers (p≤0.05, x 2 =14.44). Effects on the academic and social lives of students (Figure 1 and 2) In this study, it was found that anxiety affected the academic lives of medical students, with most students worrying about not putting in enough effort (65%), losing concentration during study (62.3%) and being forgetful (50.2%) being the top three effects. In contrast, anxiety had little effect on the social life of students. Coping strategies (Figure 3) The five coping strategies medical students employed in this study were praying and meditating (67.2%), seeking family support (66.6%), decreasing study intensity (62%), Strolling (58.2%) and seeking religious ministers (53.8%). Discussion A total of 342 respondents who freely responded to this research topic were involved in this study. A total of approximately 157 students had anxiety disorders—86 (26.61%) had moderate anxiety, and 71 (21.93%) had severe anxiety—for a total prevalence of 48.54%. These findings were obtained based on previous methods involving anxiety prevalence scoring system. According to the new scoring system for anxiety, a total of 213 students had anxiety disorders, 139 (40.6%) had severe anxiety, and 74 (21.6%) had moderate anxiety disorders. The newer classification yielded a higher prevalence, whereas the application of the older classification yielded lower and near-global prevalence; the difference observed could be due to methodology implication limitations. The prevalence rate (both in the new and old versions) is far greater than the previous prevalence rate obtained from various studies; the study performed at Babcock University reported a prevalence rate of 28.4%. This can be attributed to the standard that is placed by the school authority for passing a professional examination in school. This can also be attributed to the workload, which is inversely proportional to the amenities needed by students to cope well in school, such as a poor light supply for reading, poor water supply, poor attitudes of some lecturers toward students, long distance between the hostel area and the hospital environment for 3 rd year, 4 th year and 5 th year students. This could also be attributed to the current state of mind of some students because the 4 th -year medical students were experiencing examination preparation during our data collection. This study revealed a prevalence of 60.5% (51), 46.6% (39), 42.7% (35) and 50.2% (41%) among 3 rd year, 4 th year, 5 th year and 6 th year clinical medical students, respectively. This shows a difference between the rate in the 3 rd year and that in other years. There was a slight difference in the rate of anxiety among fourth- and fifth-year clinical medical students, while there was no significant difference in the rate of anxiety among sixth-year and third-year clinical medical students; however, there was a significant difference in the prevalence of anxiety between 3rd- and sixth-year medical students and between 4 th- and fifth-year medical students. Third-year medical students had the highest rate of anxiety, followed by sixth-year, 4 th year and, finally, fifth-year medical students. In comparison with the study performed by Naomi A. Dike, 3 rd -year students had the highest rate of anxiety, while the final ear students had the lowest In this study, more females than male clinical medical students had a higher rate of anxiety. This finding is in line with the findings of the study performed by A.O. Coker , where female students had the highest prevalence of anxiety. Those aged approximately 21-25 years also had a greater incidence of anxiety disorders than did the other age groups. Among the 12 students who smoked, a few reported symptoms of anxiety. Out of 135 students who consumed alcohol, 59 had anxiety disorders. The results of the present study revealed that anxiety was associated with variable factors, which included academic stress, sleepless nights, fear of failing a professional exam, fear of loved one, and overdemanding lecturers. Other factors, such as financial status, fellow student status, caffeine intake, fear of contracting sexually transmitted disease, social isolation and obesity, contributed little to the overall incidence of anxiety disorders. In this study, it was noted that anxiety caused some students to lose ,concentration while studying and to do poorly on their exams, while in some students, it made them put forth more effort into their studies. It also affected some students by helping them easily forget what they had read. In terms of social effects, it made students difficult to talk to someone in authority, but it had little effect on making them aggressive, making them have difficulty communicating with their colleagues and carrying out daily routine tasks. The most commonly observed coping strategies that were used in those with anxiety disorders in our study were engaging in praying, receiving emotional support from family members, reducing hours of study, resorting to pastors, engaging in exercise and strolling out with friends. Few students engaged in clubbing activities, consumed alcohol to feel better, consumed psychoactive drugs, visited hospitals, exercised, sought counseling from lecturers, consulted traditionalists or took herbal drugs. Conclusion This study showed that anxiety disorders are a menace in the lives of clinical medical students at the University of Nigeria Enugu Campus. This finding shows that proper education is important for informing school management and the population at large about anxiety and its effect on an individual. Proper education needs to be given on the causes, clinical features, effects, management and ways of preventing anxiety to reduce the prevalence of this disease. This is due to the negative effects of anxiety both on health and in other areas of life. The discovery of the involvement of students in religious activities shows that religious leaders can be involved in the prevention and multidisciplinary management of anxiety. They should be taught about anxiety disorders in detail so that they can easily discover any tail signs of anxiety disorders in any individual seeking counseling to help in the management of such people. According to our study, female students had the highest incidence of anxiety disorders. Proper study needs to be performed to identify the factors that could predispose a female to anxiety, and ways to reduce these factors should be identified. Even though finances were noted by an insignificant number of people, this need to be addressed; school management should try to establish scholarship schemes for students who are not financially buoyant. Finally, the almost nonsignificant associations of the various sociodemographic factors with anxiety show that there should always be a high index of suspicion for anxiety irrespective of religion, ethnicity, marital status and economic References 1. Anxiety disorder. Anxiety Disorder - Background Information (weebly.com) 2. Bandelow B, Michaelis S. Epidemiology of Anxiety Disorders in the 21st Century [Internet]. Dialogues in clinical neuroscience. Les Laboratoires Servier; 2015 [cited 2021Nov19]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610617/ 3. F; T. 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Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian Medical Students [Internet]. Academic medicine : journal of the Association of American Medical Colleges. U.S. National Library of Medicine; 2006 [cited 2022Jan3]. Available from: https://pubmed.ncbi.nlm.nih.gov/16565188/ 13.Benjamin J. Sadock, Samoon Ahmad, Virginia A. Sadock. Kaplan and Sadock’s Pocket Handbook of clinical psychiatry,6th edition [textbook];New York, Wolters Kluwer(publisher),1995;chapter 12, 250-273. 13. Naomi A. Dike-Israel, Dora O. Akinboye. Prevalence and Comorbidity of Depression and Anxiety among Medical Students in Babcock University, Ogun state, Nigeria. Asian Journal of Medicine and Health. 2021;19(4): 46-55. 14.A.O Coker, O.O Coker, D Sanni. Sociodemographic Correlates and Symptoms of Depression, Anxiety and Stress Among a Sample of Nigerian Medical Students. Nigerian Journal of Basic and Clinical Sciences. 2018; 15:58-62. 15. Anita H. Laidlaw. Social Anxiety in Medical Students: Implications for communication skills teaching. Medical Teacher. 2019; 31(7): 649-654. Additional Declarations The authors declare no competing interests. Supplementary Files Tables1.jpg Tables2.jpg Tables3.jpg Tables4.jpg Tables5.jpg Tables6.jpg Tables7.jpg Tables8.jpg Cite Share Download PDF Status: Posted Version 3 posted You are reading this latest preprint version Show more versions 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4243987","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":290668671,"identity":"9f03734d-41f4-46e4-8df5-5b3a92574ff9","order_by":0,"name":"EBUBE PRECIOUS ANASIUDU","email":"","orcid":"https://orcid.org/0000-0003-2464-564X","institution":"UNIVERSITY OF NIGERIA NSUKKA","correspondingAuthor":false,"prefix":"","firstName":"EBUBE","middleName":"PRECIOUS","lastName":"ANASIUDU","suffix":""},{"id":290668672,"identity":"48009069-1e9c-4bd9-adb3-31a19e6ea209","order_by":1,"name":"CHINEDU RAPHEAL 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Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003cstrong\u003eBackground information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnxiety is a physiologic reaction to triggering events with the end goal of making us rise up to the occasion and get out of certain situations. Anxiety disorders were previously called hypochondria and affect many people older than 18 years; however, they can also affect teenagers.\u003csup\u003e\u0026nbsp;[1]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eAnxiety disorders, including panic disorder with or without agoraphobia, generalized anxiety disorder, social anxiety disorder, specific phobias, and separation anxiety disorder, are the most prevalent mental disorders and are associated with immense health care costs and a high burden of disease \u003csup\u003e[2]\u003c/sup\u003e. Of the barrage of Anxiety disorders, Specific phobias are the most common, with a prevalence of 10.3%; panic disorders (with or without agoraphobia) are the next most common, with a prevalence of 6.0%; followed by social phobias (2.7%); and generalized anxiety disorders (2.2%). \u003csup\u003e[3]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eMedical education is considered to be one of the most academically and emotionally demanding training programs available for any profession, and consequently, the time and emotional commitment necessary for medical students to devote to their training are extensive. Such demands and stress cause a negative effect on students\u0026rsquo; psychological well-being, thus, precipitating anxiety disorders. \u003csup\u003e[4]\u0026nbsp;\u003c/sup\u003ePsychological distress (as can be caused by anxiety disorders) among medical graduates is thought to be associated with suboptimal patient care, patient safety and professionalism \u003csup\u003e[5]\u003c/sup\u003e, highlighting the massive toll anxiety disorders take on patient care, by extension.\u003c/p\u003e\n\u003cp\u003eAnxiety disorders are the most common mental disorders, affecting approximately 30% of adults during their lifetime \u003csup\u003e[6]\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e with women being more likely than men to have anxiety symptoms, with a lifetime incidence ratio of 1.7:1\u003csup\u003e[7]\u003c/sup\u003e. In the United States, anxiety disorders are the most common mental illness, affecting approximately 40 million adults each year (18.1% of the population). It is highly treatable, yet only 36.9% of patients seek medical aid. \u003csup\u003e[8]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eSimilarly, in Nigeria, anxiety disorders again predominate compared to other mental disorders, with a lifetime prevalence rate of 5.7% and a 12-month prevalence rate of 4.1%, with specific phobias being the most common subtype. \u003csup\u003e[9]\u003c/sup\u003e If an anxiety disorder is not detected early enough, it may result in a slow recovery and affect or worsen the person\u0026rsquo;s physical health. Evidence points to comorbidities being associated with anxiety disorders \u003csup\u003e[10]\u003c/sup\u003e; therefore, anxiety disorders need to be identified and managed promptly to prevent deterioration in the health of patients. Depression is also associated with significant rates of substance misuse, depressive and manic symptoms, as well as other consequences, such as decreased productivity in study studies with resultant poor academic students\u0026rsquo; performance in students with low self-esteem, lack of self-confidence, decreased memory span, lack of concentration and prolonged school years of stay.\u003c/p\u003e\n\u003cp\u003eTo the best of our knowledge, there has not been a comparative study on the prevalence and effects of anxiety disorders amongst among clinical medical students at the University of Nigeria, Enugu Campus. Thus, this study was designed to determine the prevalence of anxiety disorders among clinical medical students, the effects of anxiety disorders on their academic performance, the associated factors and the coping strategies adopted by the affected individuals.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHealth and education are the two cornerstones of human capital and form the basis of an individual\u0026rsquo;s economic productivity \u003csup\u003e[11]\u003c/sup\u003e. Anxiety disorders among students is a serious health challenge\u0026nbsp;because they\u0026nbsp;can interfere with these two cornerstones and alter their future\u0026nbsp;potential. Fortunately, studies on the subject are rapidly growing,\u0026nbsp;although disproportionately across regions. Generalization with foreign findings may not be helpful because of differences in the value of health across different countries, health insurance, and living conditions of the students, as well as in the structure of the students\u0026rsquo; support systems. Medical students, by virtue of their hectic daily schedules and demanding nature of the course are at increased risk of anxiety\u0026nbsp;disorders;\u0026nbsp;hence,\u0026nbsp;there is a\u0026nbsp;need to properly elucidate its possible causes, varied\u0026nbsp;presentations\u0026nbsp;and institute\u0026nbsp;therapies. Compared to the general population, medical students have greater levels of anxiety. \u003csup\u003e[12]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eMedical students in Nigeria are prone to a spectrum of anxiety disorders. This susceptibility is influenced by sociodemographic characteristics.\u003csup\u003e[13]\u003c/sup\u003e These characteristics can include age at school, gender, allowances, relationships with friends or parents, and marital status.\u003c/p\u003e\n\u003cp\u003eThis study contributes immeasurably to the literature on anxiety disorders among medical students at the University of Nigeria. This comparative study therefore aimed to fill some of these key research gaps by studying anxiety disorders, thus helping us better understand the clinical features and possible factors associated with anxiety disorders among medical students at the UNIVERSITY OF NIGERIA, ENUGU CAMPUS with an end game of eradicating anxiety disorder through the development of better prevention strategies, treatment programs and rehabilitation packages.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral Objectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;This study aims aimed to determine the prevalence and associated factors of anxiety amongst disorders among clinical medical students at the University of Nigeria, Enugu campus\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSpecific Objectives\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eTo determine the prevalence of anxiety disorders among clinical medical students at the University Of Nigeria, Enugu Campus.\u003c/li\u003e\n \u003cli\u003eTo assess personal and socio-demographic sociodemographic factors associated with anxiety disorder disorders among clinical medical students at the University Of Nigeria, Enugu Campus\u003c/li\u003e\n \u003cli\u003eTo ascertain the effects of anxiety disorder disorders on the academic and social lives of clinical medical students at the University Of Nigeria, Enugu Campus\u003c/li\u003e\n \u003cli\u003eTo compare the prevalence of anxiety disorder disorders among \u0026nbsp;clinical medical students in the University Of Nigeria, Enugu Campus\u003c/li\u003e\n \u003cli\u003eTo assess coping strategies for anxiety disorders among clinical medical students at the University Of Nigeria, Enugu Campus.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Literature Review","content":"\u003cp\u003eMany students perform poorly because of anxiety. This has contributed to their adequate preparation for exams, causing some students to easily forget what they read and preventing them from being unable to produce the information in an appropriate way.\u003c/p\u003e\n\u003cp\u003eDue to these few observations concerning the effect of anxiety, a good study of anxiety among students, particularly clinical medical students, will help in discovering the causes of anxiety disorders and the underlying mechanisms involved.\u003c/p\u003e\n\u003cp\u003eAnxiety disorders are mental health disorders characterized by feelings of worry or fear that are strong enough to interfere with one\u0026rsquo;s activity.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePrevious studies examining anxiety disorder separately are rare despite the noted effect of anxiety on the academic performance of medical students, on the generation of poor coping strategies such as the use of alcohol and nicotine, and on the development of long-term effects on their performance as doctors in terms of poor work efficacy. Anxiety disorders, as a topic, have been neglected, and there is limited research on anxiety.\u003c/p\u003e\n\u003cp\u003eThere is a knowledge gap on anxiety disorders in the developing population at large and, unfortunately, among medical students in Nigeria despite the psychopathological effect of these disorders. Therefore, this study will contribute greatly to enlightening the public at large on the increasing burden of anxiety disorders among people, particularly medical students, and thus lead to the development of policies, such as the formation of a student-friendly environment and the development of counseling services and various forms of psychological therapy, that will help in curbing the prevalence of anxiety disorders among medical students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no known objective way to measure the level of difficulty a university course presents; however, there is widespread agreement that some courses are more difficult than most and that medicine and surgery as a course is constantly thought to be among the top 10 when ranked according to the level of difficulty and intensity of challenge. Medical students experience high levels of stress and anxiety (more so than do the general population), possibly because they have voluminous materials to memorize, sleep deprivation, social isolation, and so forth. In addition, many medical schools are structured to foster competition rather than cooperation, resulting in the aggravation of present stress.\u003csup\u003e\u0026nbsp;[1]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIn a meta-analysis intended to determine the global prevalence of anxiety among medical students performed by Travis Tian-Ci Quek et al. in 2019, a total of sixty-nine studies were pooled and analyzed. The studies included 40,438 medical students. Eighteen studies were from Asia, twenty-one from the Middle East, thirteen from Europe, ten from South America, four from North America, two from Oceania and one from Africa. The sample sizes of the studies ranged from 73 to 10,140, and screening instruments such as BAS 21, DASS 21, HADS and GAD 7 were utilized to assess the presence of anxiety disorders in medical students. The mean age of the individuals ranged from 18.02 years to 25.10 years. This meta-analysis revealed that the average prevalence of NAFLD among the total number of studies pooled was 35.4%. When the prevalence was stratified by sex, we found that female medical students had a greater incidence of anxiety (38.0%) than male students did (27.6%), but this difference was not statistically significant (p = 0.16).\u0026nbsp;It was suggested that destigmatization of mental illness and the culture of help-seeking behavior should start from the school\u0026rsquo;s administration, which includes making rules that would favor an increase in the help-seeking behavior of those with mental illness.\u003csup\u003e[4]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIn another study by Naomi A. Dike-Israel et al.on the prevalence and comorbidity of depression and anxiety among medical students at Babcock University, Ogun State, Nigeria, a cross-sectional survey was conducted with undergraduate medical students who were recruited randomly from classes. The sample included 225 medical students (68.8% women and 30.2% men), with a mean age of 19.09 years (\u0026plusmn;2.14 S.D.). An online survey utilizing the Beck Anxiety Inventory (BAI) was administered to make a provisional diagnosis of anxiety and its severity. The results indicated a 28.4% prevalence of anxiety among the respondents. The study determined that the year of study with the highest prevalence of anxiety and depression was year 3, and the year of study with the lowest prevalence was year 6. From this study, suggestions such as the creation of sensitization programs for mental disorders, the provision of mandatory counseling services for students at least once in every academic session and the provision of help-lines for students who would like to be anonymous were made by the people who did this study with the aim of reducing the prevalence of anxiety and depression, which is also a comorbidity and thus the long-term effects of these mental disorders. One limitation of this study is that it focused only on one institution. \u003csup\u003e[13]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eA.O. Coker et al. studied the \u0026ldquo;sociodemographic correlates and symptoms of depression, anxiety and stress among a sample of Nigerian medical students.\u0026rsquo;\u0026rsquo; This was a cross-sectional descriptive study of 240 medical students in the 2\u003csup\u003end\u003c/sup\u003e to 6\u003csup\u003eth\u003c/sup\u003e academic years of study. The Depression Anxiety Stress Scale 21 (DASS-21) was analyzed using the International Business Machine Statistical Package for the Social Science version 18 (IBM-SPSS). Unlike previous studies that showed a high prevalence of these disorders, this study showed a low prevalence of depression and anxiety, which was attributed to the close proximity of the students\u0026rsquo; hostel to the college and the friendly atmosphere of the school. According to the sociodemographic relationship with the incidence of NAFLD, individuals aged 23-28 years experienced more depression, anxiety and stress than did those aged 29-34 years. Male participants experienced more depression and anxiety than female participants did, although female students were known to be more stressed. In this study, it was also noted that some students resorted to poor coping habits. The limitation of this study was the use of a homogenous sample of medical students from one university. \u003csup\u003e[14]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnita H Laidlaw studied social anxiety at the University of St Andrews in 2009 among a total of 247 medical students, 60% of whom were female. The students completed a questionnaire survey measuring levels of social anxiety and attitudes toward communication skills teaching. A total of 300 medical students were included, 247 of whom completed the questionnaire (82% response rate). The questionnaire included the social phobia scale, social interaction anxiety scale, reduced version of the Communication Skills Attitude Scale and several demographic questions. In comparison with that of the other subgroups, the prevalence of social anxiety was lower among medical students. Compared with their male counterparts, female students had a greater level of social anxiety. One of the studies the author examined noted that adolescents suffering from high levels of social anxiety may be less likely to achieve the grades to enable them to apply for medical school. The study revealed that social anxiety contributes to a negative attitude toward teaching communication skills and may impact participation in group workshops. The impact of social anxiety on the ability of students to communicate with potential patients during practical examinations was not examined in this study. The author also noted that social anxiety was positively correlated with alcohol dependence and problems caused by alcohol. \u003csup\u003e[15]\u003c/sup\u003e\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cstrong\u003eSTUDY AREA\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was carried out at the University of Nigeria, the Enugu Campus, and the Ituku Ozalla campus as well as at the University of Nigeria Teaching Hospital, Old Site, Enugu.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSTUDY POPULATION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUndergraduate clinical medical students at the University of Nigeria, Enugu Campus. There are different hostels for the different classes of clinical medical students. The clinical medical students in the University of Nigeria Teaching Hospital Ituku \u0026nbsp;and Oldsite, and the clinical students in the University of Nigeria Enugu Campus participated\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSTUDY DESIGN\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study design was a cross-sectional epidemiological study of the descriptive type among Clinical medical students at the University of Nigeria Teaching Hospital, Enugu.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eINCLUSION CRITERIA\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the clinical medical students were from the University of Nigeria, Nsukka. The sample included 4\u003csup\u003eth\u003c/sup\u003e, 5\u003csup\u003eth,\u003c/sup\u003e and 6\u003csup\u003eth\u003c/sup\u003e year medical students. It also included the senior 3\u003csup\u003erd\u003c/sup\u003e year medical students who just started their clinical program\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEXCLUSION CRITERIA\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUNEC students from other faculties\u003c/p\u003e\n\u003cp\u003ePreclinical students at the Nsukka and Enugu campuses\u003c/p\u003e\n\u003cp\u003ePreclinical and Clinical students who were not available during our data collection\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSAMPLING METHOD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was calculated using the Cochrane sample size formula\u003c/p\u003e\n\u003cp\u003eMinimum sample size, n = Z\u003csup\u003e2\u0026nbsp;\u003c/sup\u003ep(1-p)/d\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003ewhere Z = 1.96 at the 95% confidence limit\u003c/p\u003e\n\u003cp\u003eP = Prevalence of anxiety disorder from a previous study (28.4%)\u003c/p\u003e\n\u003cp\u003ed = Margin of error tolerated, usually 5% (or 0.05)\u003c/p\u003e\n\u003cp\u003eN = \u003cu\u003e1.96\u003csup\u003e2\u003c/sup\u003e \u0026times; 0.284 (1-0.284)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(0.05)\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;=312.467 students\u003c/p\u003e\n\u003cp\u003eThe addition of 10% to compensate for attrition will increase the sample size too\u003c/p\u003e\n\u003cp\u003e10% of 312.467 = 31.2467\u003c/p\u003e\n\u003cp\u003eMinimum Sample Size = 312.467 + 31.2467 = 343.7137\u003c/p\u003e\n\u003cp\u003eApproximately 344 students\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eprobability sampling via the simple random sampling technique was used.\u003c/p\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDATA COLLECTION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed by collecting primary data via a self-administered online questionnaire, which was completed by the respondents. The questionnaire was pretested at Enugu State University Teaching Hospital Parklane\u003c/p\u003e\n\u003cp\u003eIt had eight sections that assessed the following\u003c/p\u003e\n\u003cp\u003eSECTION A: Personal and Sociodemographic Data\u003c/p\u003e\n\u003cp\u003eSECTION B: Parental Demographic Data\u003c/p\u003e\n\u003cp\u003eSECTION C: Level of awareness of anxiety disorders\u003c/p\u003e\n\u003cp\u003eSECTION D: Assessment of prevalence of anxiety disorder using the Beck\u0026rsquo;s Anxiety Inventory (1988) with a modified time frame assessing for presence of anxiety symptoms since 2\u003csup\u003end\u003c/sup\u003e MBBS. The instrument consists of 21 items that are answered using a multiple choice scale. Each item has a score of 0\u0026ndash;3, with higher scores indicating more severe symptoms. The inventory divides the scores into low (minimal and mild), moderate and severe anxiety. Scores ranged from 0-21 for mild anxiety, 22-35 for moderate anxiety and 36-63 for severe anxiety.\u003cbr\u003e\u0026nbsp;The BAI measures emotional, cognitive and physiological symptoms of anxiety.\u003c/p\u003e\n\u003cp\u003eSECTION E: Assessment of coping strategies\u003c/p\u003e\n\u003cp\u003eSECTION F: Effects of anxiety disorders on the Academic Life of Clinical Students\u003c/p\u003e\n\u003cp\u003eSECTION G: Effects of anxiety disorders on the Social Life of Clinical Students\u003c/p\u003e\n\u003cp\u003eSECTION H: Factors associated with anxiety\u003c/p\u003e\n\u003cp\u003eData analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 26.0. The data are presented in the tables.\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained prior to the field work from the Department of Community Medicine UNTH as well as the Student Affairs Department UNN, Enugu and Ituku Ozalla Campuses. The respondents\u0026rsquo; data were carefully handled.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003eResponse rate and characteristics of participants (Tables 1 and 2)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 1265 clinical medical students enrolled at the University of Nigeria Teaching Hospital, Enugu,342 (27%) participated in the research. A total of 224 (65.5%) of them were aged between 21 and 25 years, while 75 (21.9%) were aged between 16 and 20 years. The rest were older than 25 years. The mean age of the participants was 22.59 \u0026plusmn;2.67 years. There was almost equal gender representation, with 172 females (50.3%) and 170 males (49.7%). The year of study of the respondents was distributed as follows: 28.7% in 300 L, 21.3% in 400 L, and 22.2% in 500 L; 27.8% in 600 L. In this study, 57.6% had monthly incomes greater than 20,000 naira, 98% were unmarried, and 83.9% had their parents married still. When asked about their awareness of anxiety, 97.4% had heard about anxiety, with approximately 60.2% hearing about it in the mass media. The respondents were asked to self-rate their anxiety levels, and 27.5% admitted that they were overly anxious. Approximately 78.7% of respondents thought people with anxiety disorders should be counseled as against being ignored or given medications. A majority (86%) believe that anxiety can be cured.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003ePrevalence of anxiety symptoms among medical students (Table 4)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen the BAI (with adjusted time range) was self-administered, moderate anxiety symptoms were prevalent in 26.6% of the students, and 21.9% of the students had severe anxiety according to the scoring of the 1988 version of the BAI. Considering the scoring of the 1992 BAI, moderate and severe symptoms had incidences of 21.6% and 40.6%, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAssociations between student characteristics (Tables 5 and 6)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study revealed that anxiety was significantly associated with sex \u003cstrong\u003e(p=0.001, x\u003csup\u003e2\u003c/sup\u003e=13.77)\u003c/strong\u003e, fear of failure of professional exams \u003cstrong\u003e(p\u0026le;0.05, x\u003csup\u003e2\u003c/sup\u003e=22.5)\u003c/strong\u003e, sleepless nights \u003cstrong\u003e(p=0.002, x\u003csup\u003e2\u003c/sup\u003e=28.47)\u003c/strong\u003e, parental pressure \u003cstrong\u003e(p\u0026le;0.05, x\u003csup\u003e2\u003c/sup\u003e=22.08)\u003c/strong\u003e, fear of fellow students \u003cstrong\u003e(p\u0026le;0.05, x\u003csup\u003e2\u003c/sup\u003e=13.13)\u003c/strong\u003e, academic stress \u003cstrong\u003e(p=0.02, x\u003csup\u003e2\u003c/sup\u003e=8.16)\u003c/strong\u003e and overdemanding lecturers \u003cstrong\u003e(p\u0026le;0.05, x\u003csup\u003e2\u003c/sup\u003e=14.44).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eEffects on the academic and social lives of students (Figure 1 and 2)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, it was found that anxiety affected the academic lives of medical students, with most students worrying about not putting in enough effort (65%), losing concentration during study (62.3%) and being forgetful (50.2%) being the top three effects. In contrast, anxiety had little effect on the social life of students.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eCoping strategies (Figure 3)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe five coping strategies medical students employed in this study were praying and meditating (67.2%), seeking family support (66.6%), decreasing study intensity (62%), Strolling (58.2%) and seeking religious ministers (53.8%).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eA total of 342 respondents who freely responded to this research topic were involved in this study. A total of approximately 157 students had anxiety disorders\u0026mdash;86 (26.61%) had moderate anxiety, and 71 (21.93%) had severe anxiety\u0026mdash;for a total prevalence of 48.54%. These findings were obtained based on previous methods involving anxiety prevalence scoring system. According to the new scoring system for anxiety, a total of 213 students had anxiety disorders, 139 (40.6%) had severe anxiety, and 74 (21.6%) had moderate anxiety disorders. The newer classification yielded a higher prevalence, whereas the application of the older classification yielded lower and near-global prevalence; the difference observed could be due to methodology implication limitations. The prevalence rate (both in the new and old versions) is far greater than the previous prevalence rate obtained from various studies; the study performed at Babcock University reported a prevalence rate of 28.4%. This can be attributed to the standard that is placed by the school authority for passing a professional examination in school. This can also be attributed to the workload, which is inversely proportional to the amenities needed by students to cope well in school, such as a poor light supply for reading, poor water supply, poor attitudes of some lecturers toward students, long distance between the hostel area and the hospital environment for 3\u003csup\u003erd\u003c/sup\u003e year, 4\u003csup\u003eth\u003c/sup\u003e year and 5\u003csup\u003eth\u003c/sup\u003e year students. This could also be attributed to the current state of mind of some students because the 4\u003csup\u003eth\u003c/sup\u003e-year medical students were experiencing examination preparation during our data collection.\u003c/p\u003e\n\u003cp\u003eThis study revealed a prevalence of 60.5% (51), 46.6% (39), 42.7% (35) and 50.2% (41%) among 3\u003csup\u003erd\u003c/sup\u003e year, 4\u003csup\u003eth\u003c/sup\u003e year, 5\u003csup\u003eth\u003c/sup\u003e year and 6\u003csup\u003eth\u003c/sup\u003e year clinical medical students, respectively. This shows a difference between the rate in the 3\u003csup\u003erd\u003c/sup\u003e year and that in other years. There was a slight difference in the rate of anxiety among fourth- and fifth-year clinical medical students, while there was no significant difference in the rate of anxiety among sixth-year and third-year clinical medical students; however, there was a significant difference in the prevalence of anxiety between 3rd- and sixth-year medical students and between 4\u003csup\u003eth-\u003c/sup\u003e and fifth-year medical students. Third-year medical students had the highest rate of anxiety, followed by sixth-year, 4\u003csup\u003eth\u0026nbsp;\u003c/sup\u003eyear and, finally, fifth-year medical students. In comparison with the study performed by Naomi A. Dike, 3\u003csup\u003erd\u003c/sup\u003e-year students had the highest rate of anxiety, while the final ear students had the lowest\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;In this study, more females than male clinical medical students had a higher rate of anxiety. This finding is in line with the findings of the study performed by A.O. Coker , where female students had the highest prevalence of anxiety. Those aged approximately 21-25 years also had a greater incidence of anxiety disorders than did the other age groups. Among the 12 students who smoked, a few reported symptoms of anxiety. Out of 135 students who consumed alcohol, 59 had anxiety disorders. The results of the present study revealed that anxiety was associated with variable factors, which included academic stress, sleepless nights, fear of failing a professional exam, fear of loved one, and overdemanding lecturers. Other factors, such as financial status, fellow student status, caffeine intake, fear of contracting sexually transmitted disease, social isolation and obesity, contributed little to the overall incidence of anxiety disorders.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;In this study, it was noted that anxiety caused some students to lose ,concentration while studying and to do poorly on their exams, while in some students, it made them put forth more effort into their studies. It also affected some students by helping them easily forget what they had read.\u0026nbsp;In terms of social effects, it made students difficult to talk to someone in authority, but it had little effect on making them aggressive, making them have difficulty communicating with their colleagues and carrying out daily routine tasks.\u003c/p\u003e\n\u003cp\u003eThe most commonly observed coping strategies that were used in those with anxiety disorders in our study were engaging in praying, receiving emotional support from family members, reducing hours of study, resorting to pastors, engaging in exercise and strolling out with friends. Few students engaged in clubbing activities, consumed alcohol to feel better, consumed psychoactive drugs, visited hospitals, exercised, sought counseling from lecturers, consulted traditionalists or took herbal drugs.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e\u0026nbsp; This study showed that anxiety disorders are a menace in the lives of clinical medical students at the University of Nigeria Enugu Campus. This finding shows that proper education is important for informing school management and the population at large about anxiety and its effect on an individual. Proper education needs to be given on the causes, clinical features, effects, management and ways of preventing anxiety to reduce the prevalence of this disease. This is due to the negative effects of anxiety both on health and in other areas of life.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;The discovery of the involvement of students in religious activities shows that religious leaders can be involved in the prevention and multidisciplinary management of anxiety. They should be taught about anxiety disorders in detail so that they can easily discover any tail signs of anxiety disorders in any individual seeking counseling to help in the management of such people.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; According to our study, female students had the highest incidence of anxiety disorders. Proper study needs to be performed to identify the factors that could predispose a female to anxiety, and ways to reduce these factors should be identified. Even though finances were noted by an insignificant number of people, this need to be addressed; school management should try to establish scholarship schemes for students who are not financially buoyant. Finally, the almost nonsignificant associations of the various sociodemographic factors with anxiety show that there should always be a high index of suspicion for anxiety irrespective of religion, ethnicity, marital status and economic\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e1.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Anxiety disorder. Anxiety Disorder - Background Information (weebly.com)\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Bandelow B, Michaelis S. Epidemiology of Anxiety Disorders in the 21st Century [Internet]. Dialogues in clinical neuroscience. Les Laboratoires Servier; 2015 [cited 2021Nov19]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610617/\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;F; T. Anxiety disorders: A review of current literature [Internet]. Dialogues in clinical neuroscience. U.S. National Library of Medicine; 2017 [cited 2022Jan3]. Available from: https://pubmed.ncbi.nlm.nih.gov/28867933/\u003c/p\u003e\n\u003cp\u003e4.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Tian-Ci Quek T, Wai-San Tam W, X. Tran B, Zhang M, Zhang Z, Su-Hui Ho C, et al. The global prevalence of anxiety among medical students: A meta-analysis [Internet]. MDPI. Multidisciplinary Digital Publishing Institute; 2019 [cited 2021Nov19]. Available from: https://www.mdpi.com/1660-4601/16/15/2735\u003c/p\u003e\n\u003cp\u003e5.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;AL; STDBKAWJEB. Burnout and self-reported patient care in an Internal Medicine Residency Program [Internet]. Annals of internal medicine. U.S. National Library of Medicine; 2002 [cited 2022Jan3]. Available from: https://pubmed.ncbi.nlm.nih.gov/11874308/\u003c/p\u003e\n\u003cp\u003e6.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;American Psychiatric Association. What Are Anxiety Disorders? [Internet]. What are anxiety disorders? 2021 [cited 2021Nov19]. Available from: https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders\u003c/p\u003e\n\u003cp\u003e7.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness [Internet]. Journal of psychiatric research. U.S. National Library of Medicine; 2011 [cited 2021Nov19]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3135672/\u003c/p\u003e\n\u003cp\u003e8.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Anxiety and Depression Association of America. Facts \u0026amp;amp; Statistics: Anxiety and Depression Association of America, ADAA [Internet]. Facts \u0026amp;amp; Statistics | Anxiety and Depression Association of America, ADAA. 2021 [cited 2022Jan3]. Available from: https://adaa.org/understanding-anxiety/facts-statistics\u003c/p\u003e\n\u003cp\u003e9.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Gureje O. Lifetime and 12-month prevalence of mental disorders in ... [Internet]. Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of Mental Health and Well-Being. 2006 [cited 2022Jan3].Availablefrom:https://www.researchgate.net/publication/7131891_Lifetime_and_12month_prevalence_of_mental_disorders_in_the_Nigerian_Survey_of_Mental_Health_and_Well-Being\u003c/p\u003e\n\u003cp\u003e10.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;SA; MKRS. Comorbidity in anxiety disorders [Internet]. Current topics in behavioral neurosciences. U.S. National Library of Medicine; 2010 [cited 2021Nov19]. Available from: https://pubmed.ncbi.nlm.nih.gov/21309105/\u003c/p\u003e\n\u003cp\u003e11.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;World Health Organization. Macroeconomics and health: Investing in health for Economic Development: Executive summary/report of the commission on macroeconomics and health [Internet]. World Health Organization. World Health Organization; 1970 [cited 2021Nov19]. Available from: https://apps.who.int/iris/handle/10665/42463\u003c/p\u003e\n\u003cp\u003e12.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;TD; DLNTMRS. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian Medical Students [Internet]. Academic medicine : journal of the Association of American Medical Colleges. U.S. National Library of Medicine; 2006 [cited 2022Jan3]. Available from: https://pubmed.ncbi.nlm.nih.gov/16565188/\u003c/p\u003e\n\u003cp\u003e13.Benjamin J. Sadock, Samoon Ahmad, Virginia A. Sadock. Kaplan and Sadock\u0026rsquo;s Pocket Handbook of clinical psychiatry,6th edition [textbook];New York, Wolters Kluwer(publisher),1995;chapter 12, 250-273.\u003c/p\u003e\n\u003cp\u003e13. Naomi A. Dike-Israel, Dora O. Akinboye. Prevalence and Comorbidity of Depression and Anxiety among Medical Students in Babcock University, Ogun state, Nigeria. Asian Journal of Medicine and Health. 2021;19(4): 46-55.\u003c/p\u003e\n\u003cp\u003e14.A.O Coker, O.O Coker, D Sanni. Sociodemographic Correlates and Symptoms of Depression, Anxiety and Stress Among a Sample of Nigerian Medical Students. Nigerian Journal of Basic and Clinical Sciences. 2018; 15:58-62.\u003c/p\u003e\n\u003cp\u003e15. Anita H. Laidlaw. Social Anxiety in Medical Students: Implications for communication skills teaching. Medical Teacher. 2019; 31(7): 649-654.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"UNIVERSITY OF NIGERIA NSUKKA","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ANXIETY, CLINICAL","lastPublishedDoi":"10.21203/rs.3.rs-4243987/v3","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4243987/v3","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAnxiety disorders are combinations of emotional disorders that have profound effects on the mental status of individuals. One of the most common presentations\u003cu\u003e \u003c/u\u003eis a panic attack, in\u003cu\u003e \u003c/u\u003ewhich students experience attacks that are especially close to tests and examinations due to the cumbersome academic workload.\u003c/p\u003e\n\u003cp\u003eThis paper reviews the effect of anxiety disorders among medical students at the University of Nigeria Enugu Campus. An online questionnaire was distributed to the 3\u003csup\u003erd\u003c/sup\u003e, 4\u003csup\u003eth,\u003c/sup\u003e and 5\u003csup\u003eth\u003c/sup\u003e MBBS classes in an\u003cu\u003e \u003c/u\u003eattempt to determine the prevalence and knowledge of anxiety in these classes, and\u003cu\u003e \u003c/u\u003eany known coping mechanisms and to perform a comparative study on socio-demographic, academic, and personal factors.\u003c/p\u003e\n\u003cp\u003eThe results revealed a preponderance in females and fear of failure and a\u003cu\u003e \u003c/u\u003ehigh dependence on receiving emotional support from family, praying and meditating as coping mechanisms.\u003c/p\u003e\n\u003cp\u003eHopefully, this study will inform academic authorities on the need to adjust syllables due to increased workload as a contributing factor of anxiety disorder and school authorities on the need for a closed student-lecturer interaction.\u003c/p\u003e","manuscriptTitle":"Anxiety Disorder Amongst Clinical Medical Students at the University of Nigeria Teaching Hospital, ENUGU CAMPUS: a Comparative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":3,"date":"2024-04-16 21:28:44","doi":"10.21203/rs.3.rs-4243987/v3","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":2,"date":"2024-04-12 20:20:07","doi":"10.21203/rs.3.rs-4243987/v2","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2024-04-11 18:22:54","doi":"10.21203/rs.3.rs-4243987/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ad056947-75e2-4dbc-b7bd-1f2988878dfb","owner":[],"postedDate":"April 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":30646818,"name":"Psychiatry"}],"tags":[],"updatedAt":"2024-04-11T18:22:54+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-16 21:28:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v3","identity":"rs-4243987","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4243987","identity":"rs-4243987","version":["v3"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}