Journal of College of Medical Sciences-Nepal, Vol-20, No.

1, Jan-Mar 2024
Original Research Article ISSN: 2091-0657 (Print); 2091-0673 (Online) Open Access
DOI:10.3126/jcmsn.v20i1.60608
Impact of Academic Stress on Help-Seeking Attitudes Among Nursing
Students of Kathmandu District
Sophee Niraula,1 Kushalata Baral2
Department of Biostatistics and Epidemiology, Rutgers School of Public Health, New Jersey, USA, 2Department of Public
1

Health, Nobel College, Pokhara University, Sinamangal, Kathmandu, Nepal.

ABSTRACT
Background
Depression, anxiety and stress are treatable conditions. However, a vast majority of people avoid seeking
professional help. Interventions aiming to improve help-seeking attitudes among affected individuals,
particularly within academic settings, often demonstrate limited efficacy. This study explores the relationship
between academic stress and help-seeking attitudes among nursing students.
Methods
A descriptive cross-sectional study was conducted among 300 nursing students in Kathmandu district using
simple random sampling. Data were collected using the Depression Anxiety and Stress Scale (DASS21) and
additional survey questions. Statistical analysis employed chi-square tests to explore relationships between
variables.
Results
Findings indicated that 14% of respondents had mild depression, 30% moderate depression, and 8.7% severe
depression. Similarly, levels of anxiety and stress were observed, with significant associations between
depression and stress related to academics (p-value 0.002). Help-seeking preferences revealed that students
were more inclined to seek support from friends or intimate partners.
Conclusions
This study highlights the prevalence of depression, anxiety, and stress among nursing students with notable
associations to their academia. Importantly, the findings emphasize the need for tailored interventions to
address mental health concerns and foster proactive help-seeking attitudes among students. Further research
and targeted strategies are warranted to enhance the effectiveness of interventions in this context.
Keywords: academic stress; depression; anxiety; stress; help-seeking attitudes.

INTRODUCTION high rates of depression (51.3%), anxiety (66.9%),

Depression, anxiety, and stress are prevalent global and stress (53%) particularly in the 5th semester.
mental health concerns affecting 1 in 8 people Female students report higher scores than males.4
worldwide according to the WHO.1 Nursing students Similar trends are likely in Nepal. Despite high
face higher risk of mental health issues due to intense mental health issues nursing students seek help less
training and exposure to trauma in clinical rotations.2,5 due to stigma, fear, and unawareness of resources.6-8
Studies consistently show high rates of mental Poor help-seeking behavior exacerbates mental
health issues among nursing students globally. In health issues, academic challenges, and dropout
Southeast Asia depression rates were 29.4%, anxiety risk in nursing programs.9 This study aims to gauge
42.4%, stress 16.4% with 7-8% reporting current depression, anxiety, stress, and help-seeking among
suicidality.3 In India, medical students grapple with Kathmandu nursing students.
Correspondence: Sophee Niraula, Department of Biostatistics and Epidemiology, Rutgers School of Public Health, New
Jersey, USA. Email: [email protected], Phone: +1 551-804-1903. rticle received:2023-12-05. Article accepted:2024-03-14.

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METHODS Table 1. Socio demographic variables.

This study utilized a descriptive cross-sectional Variables Frequency (%)
design to examine the mental health status and help- Age
seeking behavior among nursing students across six ≤ 18 31 (10.3%)
colleges in the Kathmandu district. Ethical approval 19 to 20 42 (14%)
was secured from the Institutional Review Committee > 20 227 (75.7%)
at Nobel College (Ref No. PHIRC 128/2018), and Mean = 20.70
informed consent was obtained from all participating Religion
students. A total of 300 undergraduate nursing Hinduism 256 (85.3%)
students were selected through simple random Buddhism 33 (11%)
sampling from the targeted colleges. Data were Others 11 (3.7%)
collected using a semi-structured questionnaire Education level
that covered sociodemographic factors, academic 1st year 98 (32.7%)
stressors, family history of psychiatric disorders, 2 year
nd
60 (20%)
and help-seeking behavior. Additionally, the 3 year
rd
71 (23.7%)
Depression Anxiety Stress Scale (DASS-21) and 4 year
th
71 (23.7%)
the modified General Help-Seeking Questionnaire Accommodation
(GHSQ) were employed to assess mental health Home 166 (55.3%)
states and help-seeking intentions, respectively. The Hostel 74 (24.7)
DASS-21, comprising three subscales, measured Rented room 60 (20%)
levels of depression, anxiety, and stress, while the Family income per month
GHSQ, adapted into a 4-point Likert scale, captured < 25000 28 (9.3%)
participants' intentions regarding help-seeking 25000-50000 150 (50%)
from various sources. Data entry and analysis > 50000 122 (40.7%)
were performed using SPSS version 16, employing
descriptive statistics, analysis of variance (ANOVA)
was also employed in this study to explore further
associations between mental health indicators
and different variables among nursing students.
This methodological approach aimed to provide
comprehensive insights into the mental health
landscape and help-seeking behavior among nursing
students, contributing valuable information to
existing literature on this topic.

RESULTS Figure 1. Depression anxiety and stress levels

Table 1 outlines key demographic findings. The mean using DASS-21.
student age was 20.70 years and Hinduism is the
8.7% reported severe depression. In terms of anxiety,
dominant religion. There is a higher representation
19.3% of respondents demonstrated a normal level,
from 1st-year B.Sc. nursing students.
while 28% experienced moderate anxiety and 19%
Figure 1 illustrates the assessment of depression,
reported severe anxiety. The measurement of stress
anxiety, and stress levels using standard cut-off
levels indicated that 47% of respondents had a
points. A significant portion of respondents (38.7%)
normal stress level, while 21% reported moderate
exhibited a normal level of depression, while 30%
stress, and 13% reported severe stress.
experienced moderate depression. Additionally,

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 Niraula et al. Impact of Academic Stress on Help-Seeking Attitudes Among Nursing Students..

Table 2. Association between depression and relationship Table 5. Association between seeking professional help and
problem. reason/barrier behind not doing so.

Relationship problem Depression Reason behind not seeking help

p -value I was afraid
in family/friends No Yes
Yes 8 (6.9%) 148 (80.4%) Variables I preferred to ask for I didn’t
p-value
<0.001 n=256 to manage help or what perceive Others
No 108 (93.1%) 36 (19.6%) others would the need
myself
think/Privacy for it
Table 2 shows a highly statistically significant
concerns
association (p-value < 0.001) between depression Have you ever seen a mental health professional?
and relationship problems within the family or Yes 49 (36.8%) 21 (45.7%) 6 (13%) 14(45.2%)
with friends. This highlights the notable connection 0.003
No 84(63.2%) 25(54.3%) 40(87%) 17(54.8%)
between depression and challenges in interpersonal
In Table 5, out of 256 respondents experiencing some
relationships.
form of depression, anxiety, or stress, the p-value for
Table 3. Association between depression and stress
seeking help from a mental health professional was
due to academics.
0.003. This includes exploring the reasons or barriers
Stress due to Depression
p-value preventing them from seeking help for personal
academics No Yes
Yes 75 (64.7%) 148 (80.4%) problems.
0.002
No 41 (35.3%) 36 (19.6%) DISCUSSION
In Table 3, a statistically significant association is This study explores the mental well-being of nursing
observed with a p-value of 0.002, underscoring students, revealing insights into the challenges they
that students experiencing stress due to academic face and their coping mechanisms. The participants,
pressures are more likely to have depression. This averaging 20.70 years, present a diverse demographic,
finding emphasizes a noteworthy association between differing from a comparable study in Sri Lanka10
depression and the challenges posed by academic and emphasizing the varied age distribution in
stressors and workload. academic settings. High levels of academic stress
(74.3%) and perceived leisure limitations (52.3%)
Table 4. Association between socio demographic
variables and personal information. highlight the intricate hurdles nursing students
Stress navigate, resonating with global concerns identified
Variables p-value
No Yes in a Hong Kong study.11 Utilizing the Depression
Relationship problem in family/friends
Anxiety Stress Scale (DASS-21), our findings
Yes 13 (9.2%) 51 (32.1%)
<0.001 indicate that 38.7% exhibit normal depression levels
No 128 (90.8%) 108 (67.9%)
Stress due to academics and 30% report moderate levels, aligning with cross-
Yes 65 (44.5%) 39 (41.5%) cultural similarities found in Sri Lanka10. The study
0.071
No 81 (55.5%) 55 (58.5%)
emphasizes the crucial role of familial and social
Lack of opportunities for leisure activities
networks in student support, with parents being the
Yes 64 (45.4% 93 (58.5%)
0.023 primary source, in contrast to an Australian study.12
No 77 (54.6%) 66 (41.5%)
Exploration of why students may avoid professional
Table 4 shows a strong link (p < 0.001) between
help reveals a self-reliant approach (51.7%), differing
issues in family or with friends and stress. However,
from a U.S. study13 and emphasizing cultural
there's no clear connection between stress from influences. Associations between depression and
academics and overall stress (p = 0.071). On the relationship issues, as well as academic stress, mirror
other hand, there's a noticeable link (p = 0.023) patterns identified in Hong Kong11, emphasizing
between limited opportunities for leisure activities consistency across diverse academic environments.
and stress, indicating that having fewer chances for Positive correlations between depression, anxiety,
leisure can contribute to higher stress levels. and stress confirm the interconnected nature of these

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mental health dimensions, contributing nuanced depression, anxiety, and stress among undergraduate
insights to the broader understanding of mental nursing students. Given the strong positive
well-being in academic settings and advocating for relationship observed between these mental health
more comprehensive and culturally sensitive support dimensions, holistic strategies are warranted. Root-
mechanisms. cause investigations, etiologic studies, and effective
CONCLUSIONS interventions should focus on the significant
In conclusion, this study provides a comprehensive associations with academic stress and limited leisure
examination of mental health indicators among opportunities. Additionally, future research should
nursing students. The findings reveal a significant explore the contributions of daily stressors, social
prevalence of academic stress, perceived dearth of media, interpersonal skills, and economic factors
leisure activities, and moderate levels of depression. to develop comprehensive support mechanisms for
Students primarily seek support from familial and nursing students' mental well-being.
social networks, while self-management remains a ACKNOWLEDGEMENT
prevalent coping mechanism. The interconnectedness I would like to express my sincere gratitude to my
of academic, interpersonal, and mental health supervisor, Ms. Kushalata Baral, and the entire
challenges is evident in the significant associations public health department at Nobel College for
between depression, anxiety, stress, and relationship their invaluable guidance and support throughout
problems. the research process. I would also like to thank the
college administration and the participating students
Recommendations
for their cooperation and contributions.
The study underscores the urgent need for targeted
interventions to address the high prevalence of
Conflict of interest: None

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Citation: Niraula S, Baral K. Impact of Academic Stress on Help-Seeking Attitudes Among Nursing Students of
Kathmandu District. JCMS Nepal. 2024; 20(1): 63-7.

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