Abstract
Objective: This study aims to determine the prevalence of depression, anxiety, stress among undergraduate students and its association with physical activity and academic performance.
Study Design: An analytical cross-sectional study was conducted.
Place and duration of study: This was an analytical cross sectional study conducted on undergraduate students of Institute of Physical Medicine & Rehabilitation, Khyber Medical University, Peshawar
Material and Methods: Based on eligibility criteria 83 students were recruited in the study through convenience sampling technique. The sample included both male (n=33) and female students(n=50), with a mean age of 22.5 ±0.458 years. The assessment of stress, anxiety and depression, and physical activity was carried out using; The Depression, Anxiety, and Stress Scale (DASS-21) and the International Physical Activity Questionnaire respectively. Sedentary behaviour was assessed in terms of screen time.
Results: The data was analysed by SPSS version 22. Cross tabulation and Chi square test were applied to examine the association (p value < 0.05). The results of this study showed high prevalence of depression 65%, anxiety 71% and stress 57%. Stress was significantly associated with sedentary behaviour (p < 0.05). Academic performance was found to be greatly influenced by varying levels of stress and depression (p<0.05). However, no significant association was identified between physical activity and academic performance.
Conclusion: This study revealed that stress, anxiety, and depression are highly prevalent among undergraduate students. Higher levels of stress were associated with increased sedentary behaviour. Interestingly, academic performance was positively influenced by elevated levels of stress and depression.
Keywords: Anxiety, Academic Performance, Depression, Physical Activity, Stress
References
1. Singh V, Kumar A, Gupta S. Mental health prevention and promotion—A narrative review. Frontiers in psychiatry. 2022;13:898009.
2. Organization WH. World mental health report: Transforming mental health for all: World Health Organization; 2022.
3. Choudhary S, Sharma AK, Jabeen N, Magotra R. Study of Incidence of Depression, Anxiety and Stress Among the First Year Medical Students in Government Medical College. JK Science. 2019;21(2):76-80.
4. Shah SMA, Mohammad D, Qureshi MFH, Abbas MZ, Aleem S. Prevalence, psychological responses and associated correlates of depression, anxiety and stress in a global population, during the coronavirus disease (COVID-19) pandemic. Community mental health journal. 2021;57(1):101-10.
5. Mackenzie S, Wiegel JR, Mundt M, Brown D, Saewyc E, Heiligenstein E, Harahan B, Fleming M. Depression and suicide ideation among students accessing campus health care. American journal of orthopsychiatry. 2011;81(1):101.
6. Onukwuba M, Ekpe I, Amaechi D. Depression in various stages of Human Development and its relationship with Health, Diet and Genes. International Journal of Early Childhood Special Education. 2022;14(6).
7. Guthrie S, Podvigin S, Dzhumaeva L, AA M, Musheer M. ANXIETY AND ANXIETY DISORDERS: AN OVERVIEW. Turkish Journal of Physiotherapy and Rehabilitation.32:3.
8. Manosso LM, Gasparini CR, Réus GZ, Pavlovic ZM. Definitions and concepts of stress. Glutamate and neuropsychiatric disorders: Current and emerging treatments: Springer; 2022. p. 27-63.
9. Hoferichter F, Kulakow S, Raufelder D. How teacher and classmate support relate to students’ stress and academic achievement. Frontiers in psychology. 2022;13:992497.
10. Duane EA, Stewart CS, Bridgeland WM. College student suicidality and family issues. College Student Journal. 2003;37(1):135-45.
11. Izgiç F, Akyüz G, Doğan O, Kuğu N. Social phobia among university students and its relation to self-esteem and body image. The Canadian journal of psychiatry. 2004;49(9):630-4.
12. Lima M, Domingues MS, Cerqueira A. Prevalence and risk factors of common mental disorders among medical students. Revista de saude publica. 2006;40(6):1035.
13. Chan G, Koh D. Understanding the psychosocial and physical work environment in a Singapore medical school. Singapore medical journal. 2007;48(2):166.
14. Wilkinson TJ, Gill DJ, Fitzjohn J, Palmer CL, Mulder RT. The impact on students of adverse experiences during medical school. Medical teacher. 2006;28(2):129-35.
15. Guan N, Guariglia A, Moore P, Xu F, Al-Janabi H. Financial stress and depression in adults: A systematic review. PloS one. 2022;17(2):e0264041.
16. Nochaiwong S, Ruengorn C, Thavorn K, Hutton B, Awiphan R, Phosuya C, Ruanta Y, Wongpakaran N, Wongpakaran T. Global prevalence of mental health issues among the general population during the coronavirus disease-2019 pandemic: a systematic review and meta-analysis. Scientific reports. 2021;11(1):10173.
17. Macaskill A. The mental health of university students in the United Kingdom. British Journal of Guidance & Counselling. 2013;41(4):426-41.
18. Adlaf EM, Gliksman L, Demers A, Newton-Taylor B. The prevalence of elevated psychological distress among Canadian undergraduates: Findings from the 1998 Canadian Campus Survey. Journal of American College Health. 2001;50(2):67-72.
19. Chen L, Wang L, Qiu XH, Yang XX, Qiao ZX, Yang YJ, Liang Y. Depression among Chinese university students: prevalence and socio-demographic correlates. PloS one. 2013;8(3):e58379.
20. Mohd Sidik S, Rampal L, Kaneson N. Prevalence of emotional disorders among medical students in a Malaysian university. Asia Pacific Family Medicine. 2003;2(4):213-7.
21. Sreeramareddy CT, Shankar PR, Binu V, Mukhopadhyay C, Ray B, Menezes RG. Psychological morbidity, sources of stress and coping strategies among undergraduate medical students of Nepal. BMC Medical education. 2007;7(1):26.
22. Ali Z, Khalid Z, Hamza M, Darain H, Zeb A, Abidin SZU. PREVALENCE AND CORRELATES OF STRESS, ANXIETY AND DEPRESSION AMONG UNDERGRADUATE STUDENTS OF KHYBER MEDICAL UNIVERSITY, PESHAWAR; A CROSSSECTIONAL STUDY. Annals of Allied Health Sciences. 2019;5(1):23-7.
23. Afridi A, Fahim MF. Identification of stressors and Perceptional difference of stress in first and final year Doctor of Physical Therapy students; a comparative study. JPMA. 2019.
24. Shah I, Habib SH, Yousafzai YM, Ali A, Ikram S, Zia H, Said R. PERCEIVED STRESS IN UNDERGRADUATE PHYSICAL THERAPY STUDENTS OF PESHAWAR, PAKISTAN. Pakistan Journal of Physiology. 2018;14(3):60-3.
25. Regehr C, Glancy D, Pitts A. Interventions to reduce stress in university students: A review and meta-analysis. Journal of affective disorders. 2013;148(1):1-11.
26. Youssef FF. Medical student stress, burnout and depression in Trinidad and Tobago. Academic Psychiatry. 2016;40(1):69-75.
27. Rahman NIA, Ismail S, Ali RM, Alattraqchi AG, Dali W, Umar BU, Nadiger HA, Haque M. Stress among first batch of MBBS students of Faculty of Medicine and Health Sciences, Universiti Sultan Zainal Abidin, Malaysia: when final professional examination is knocking the door. Int Med J. 2015;22(4):1-6.
28. Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand S-L, Walters EE, Zaslavsky AM. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological medicine. 2002;32(6):959-76.
29. Wen CP, Wai JPM, Tsai MK, Yang YC, Cheng TYD, Lee M-C, Chan HT, Tsao CK, Tsai SP, Wu X. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. The lancet. 2011;378(9798):1244-53.
30. 30. Biddle SJ, Mutrie N. Psychology of physical activity: Determinants, well-being and interventions: Routledge; 2007.
31. Porru F, Schuring M, Bültmann U, Portoghese I, Burdorf A, Robroek SJ. Associations of university student life challenges with mental health and self-rated health: A longitudinal study with 6 months follow-up. Journal of Affective Disorders. 2022;296:250-7.
32. Guerriero MA, Dipace A, Monda A, De Maria A, Polito R, Messina G, Monda M, di Padova M, Basta A, Ruberto M. Relationship between sedentary lifestyle, physical activity and stress in university students and their life habits: A scoping review with PRISMA checklist (PRISMA-ScR). Brain Sciences. 2025;15(1):78.
33. Thivel D, Tremblay A, Genin PM, Panahi S, Rivière D, Duclos M. Physical activity, inactivity, and sedentary behaviors: definitions and implications in occupational health. Frontiers in public health. 2018;6:288.
34. Rifat MRI, Al Imran A, Badrudduza A. Educational performance analytics of undergraduate business students. International Journal of Modern Education and Computer Science. 2019;10(7):44.
35. Beiter R, Nash R, McCrady M, Rhoades D, Linscomb M, Clarahan M, Sammut S. The prevalence and correlates of depression, anxiety, and stress in a sample of college students. Journal of affective disorders. 2015;173:90-6.
36. Syed A, Ali SS, Khan M. Frequency of depression, anxiety and stress among the undergraduate physiotherapy students. Pakistan journal of medical sciences. 2018;34(2):468.
37. Khan MS, Mahmood S, Badshah A, Ali SU, Jamal Y. Prevalence of depression, anxiety and their associated factors among medical students in Karachi, Pakistan. Journal-Pakistan Medical Association. 2006;56(12):583.
38. Singh M, Goel NK, Sharma MK, Bakshi RK. Prevalence of depression, anxiety and stress among students of Punjab University, Chandigarh. Age (in years). 2017;86(211):52.8.
39. Masilamani R, Aung MMT, Bhagat V, Bakar AA, Soon TH, Yao LC, Hui NJ, Ning LZ. Prevalence of Stress and Associated Stressors among Medical Students: A Comparative Study between a Private and Public Medical School in Malaysia. Research Journal of Pharmacy and Technology. 2018;11(6):2531-7.
40. McMahon EM, Corcoran P, O’Regan G, Keeley H, Cannon M, Carli V, Wasserman C, Hadlaczky G, Sarchiapone M, Apter A. Physical activity in European adolescents and associations with anxiety, depression and well-being. European child & adolescent psychiatry. 2017;26(1):111-22.

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