Prevalence and determinants of psychosocial stress among public health students at Njala University, Sierra Leone

Abstract

Psychosocial stress is a growing public-health concern among university students worldwide and is shaped by local financial, institutional, and digital pressures. No quantitative baseline existed for public-health students at the Kowama Campus of Njala University, Bo, Sierra Leone. Against this backdrop, the present study aimed to determine the prevalence and determinants of psychosocial stress among public-health students at Njala University, Sierra Leone. This cross-sectional analytical study recruited 239 students across three academic levels: Preliminary (Prelim), Higher National Diploma (HND), and Bachelor of Science (BSc). Participants completed a structured questionnaire comprising the Perceived Stress Scale (PSS-10), the 12-item General Health Questionnaire (GHQ-12), and a 10-item checklist of institutional stressors. Data were analysed using descriptive statistics to summarise prevalence and severity, chi-square tests to examine categorical associations, Spearman’s rank correlations to explore relationships between continuous variables, and binary logistic regression to identify predictors of high stress. Both crude (cOR) and adjusted (aOR) odds ratios were reported, with high stress as the dependent variable defined as a PSS-10 score ≥ 27. Moderate-to-high stress (PSS-10 ≥ 14) affected 94.6% (95% CI 90.9–96.8) of students and high stress (≥ 27) affected 26.4% (95% CI 21.2–32.3); mean PSS-10 was 22.8 (SD 5.7). Probable psychiatric morbidity (GHQ-12 ≥ 4) was present in 82.8% (95% CI 77.6–87.1). The highest-ranked institutional stressors were heavy academic workload (mean stress-contribution score \[MSCS\] 4.12), unauthorised monetary demands (4.06), and university fee burden (3.83). In adjusted analysis, social-media use > 4 h/day (aOR 10.2, 95% CI 4.66–22.32), HND level (aOR 4.64, 95% CI 2.13–10.08), fee burden (aOR 3.73, 95% CI 1.57–8.87), high academic workload (aOR 3.44, 95% CI 1.45–8.14), self-financing (aOR 3.38, 95% CI 1.31–8.68), and female sex (aOR 2.24, 95% CI 1.07–4.73) independently predicted high stress. Psychosocial stress is highly prevalent and multifactorial in this population. Institutions should prioritise flexible fee arrangements, safeguards against informal monetary demands, and digital-wellbeing support for students.