RESEARCH ARTICLE: The effect of stress and depression on quality of life of pharmacy students in Malaysia


  • Ali Blebil Monash University Malaysia, Malaysia
  • Juman Dujaili Monash University Malaysia, Malaysia
  • Ali Haider Mohammed Monash University Malaysia, Malaysia
  • Cheng Mun Cheong Monash University Malaysia, Malaysia
  • Yishuan Hoo Monash University Malaysia, Malaysia



Depression, Malaysia, Pharmacy student, Stress, Quality of life


Objective: This study aims to determine the prevalence of stress and depression among pharmacy students, evaluate their health related quality of life (HRQoL) in Malaysia.

Methods: A cross-sectional study design was conducted among pharmacy students at eight universities from March to May 2020 across Malaysia. Instruments adopted in the survey included perceived stress scale 4 (PSS-4) for stress, patient health questionnaire-9 (PHQ-9) for depression and WHOQOL-BREF for health-related quality of life.

Results: A total of 441 students participated in the study. The overall PSS-4 score mean was 7.30 and the differences in PHQ-9 scores mean between public and private universities were not significant. A positive correlation was observed between total PSS-4 scores and PHQ-9 scores. Only 24.5% of pharmacy students reported a good quality of life, with a median score of 96.00. A Significant negative correlation was found between stress and depression against the quality of life.

Conclusions: Stress and depression play a significant role in deteriorating the quality of life of pharmacy students. This highlighted the importance of future research in developing useful interventions to improve the quality of life of university students, especially students from the medical and health science fields.

Author Biographies

Ali Blebil, Monash University Malaysia, Malaysia

School of Pharmacy

Juman Dujaili, Monash University Malaysia, Malaysia

School of Pharmacy

Ali Haider Mohammed, Monash University Malaysia, Malaysia

School of Pharmacy

Cheng Mun Cheong, Monash University Malaysia, Malaysia

School of Pharmacy

Yishuan Hoo, Monash University Malaysia, Malaysia

School of Pharmacy


AlAteeq, D.A., Aljhani, S., & AlEesa, D. (2020). Perceived stress among students in virtual classrooms during the COVID-19 outbreak in KSA. Journal of Taibah University Medical Sciences, 15(5), 398-403.

Alkatheri, A.M., Bustami, R.T., Albekairy, A.M., Alanizi, A.H., Alnafesah, R., Almodaimegh, H., Alzahem, A., Aljamaan, K., Zurnuq, S., & Qandil, A.M. (2020). Quality of Life and Stress Level Among Health Professions Students. Health Professions Education, 6(2), 201-210.

Almaghaslah, D., & Alsayari, A. (2020). The effects of the 2019 Novel Coronavirus Disease (COVID-19) outbreak on academic staff members: a case study of a pharmacy school in Saudi Arabia. Risk Management and Healthcare Policy, 13, 795

Aslan, I., Ochnik, D., & Çınar, O. (2020). Exploring Perceived Stress among Students in Turkey during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 17(23), 8961.

Basudan, S., Binanzan, N., & Alhassan, A. (2017). Depression, anxiety and stress in dental students. International journal of medical education, 8, 179

Bayram, N., & Bilgel, N. (2008). The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Social psychiatry and psychiatric epidemiology, 43(8), 667-672

Beiter, R., Nash, R., McCrady, M., Rhoades, D., Linscomb, M., Clarahan, M., & Sammut, S. (2015). The prevalence and correlates of depression, anxiety, and stress in a sample of college students. Journal of affective disorders, 173, 90-96

Bidwal, M.K., Ip, E.J., Shah, B.M., & Serino, M.J. (2015). Stress, drugs, and alcohol use among health care professional students: a focus on prescription stimulants. Journal of pharmacy practice, 28(6), 535-542

Brown, L.F., Kroenke, K., Theobald, D.E., Wu, J., & Tu, W. (2010). The association of depression and anxiety with health‐related quality of life in cancer patients with depression and/or pain. Psycho‐Oncology, 19(7), 734-741

Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of health and social behavior, 385-396

Dyrbye, L.N., Thomas, M.R., Huschka, M.M., Lawson, K.L., Novotny, P.J., Sloan, J.A., & Shanafelt, T.D. (2006). A multicenter study of burnout, depression, and quality of life in minority and nonminority US medical students. Mayo Clinic Proceedings, 81(11),

Fawzy, M., & Hamed, S.A. (2017). Psychological stress among medical students in Assiut University in Egypt. Psychiatry Research, 255, 186–194.

Fischbein, R., & Bonfine, N. (2019). Pharmacy and Medical Students’ Mental Health Symptoms, Experiences, Attitudes and Help-Seeking Behaviors. American journal of pharmaceutical education, 83(10)

Goel, N., Haque, I., Bhyan, S. J., Jain, A., Kumari, A., Hamid, K., Sreelakshmi, M., Thomas, B., & Chauhan, R. (2020). Impact of Covid-19 on Pharmacy Students in India. Preprints.

Gorczynski, P., Sims-Schouten, W., Hill, D., & Wilson, J.C. (2017). Examining mental health literacy, help seeking behaviours, and mental health outcomes in UK university students. The Journal of Mental Health Training, Education and Practice

Gurková, E. (2011). Issues in the definitions of HRQoL. Journal of Nursing, Social Studies, Public Health and Rehabilitation, 3(4), 190

Hasanah, C.I., Naing, L., & Rahman, A.R. (2003). World Health Organization Quality of Life Assessment: brief version in Bahasa Malaysia. The Medical Journal of Malaysia, 58(1), 79-88

Hennessy, C.H., Moriarty, D.G., Zack, M.M., Scherr, P.A., & Brackbill, R. (1994). Measuring health-related quality of life for public health surveillance. Public health reports, 109(5), 665

Henning, K., Ey, S., & Shaw, D. (1998). Perfectionism, the impostor phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students. Medical education, 32(5), 456-464

Hirsch, J.D., Nemlekar, P., Phuong, P., Hollenbach, K.A., Lee, K.C., Adler, D.S., & Morello, C.M. (2020). Patterns of Stress, Coping and Health-Related Quality of Life in Doctor of Pharmacy Students. American journal of pharmaceutical education, 84(3)

Hunt, K., & Gable, K.N. (2013). Prevalence of depressive symptoms and obsessive–compulsive personality traits among pharmacy students. Currents in Pharmacy Teaching and Learning, 5(6), 541-545

Ibrahim, M.B., & Abdelreheem, M.H. (2015). Prevalence of anxiety and depression among medical and pharmaceutical students in Alexandria University. Alexandria Journal of Medicine, 51(2), 167-173

Keerthi, L. & I. Madhuri. (2020). A Study on Impact of Stress on the Medical Students. IOSR Journal of Dental and Medical Sciences, 19(1), 1-3.

Kroenke, L., Spitzer, R.L., & Williams, J.B. (2001). The PHQ‐9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606-613

Locke, D.E., Decker, P.A., Sloan, J.A., Brown, P.D., Malec, J.F., Clark, M.M., Rummans, T.A., Ballman, K.V., Schaefer, P.L., & Buckner, J. C. (2007). Validation of single-item linear analog scale assessment of quality of life in neuro-oncology patients. Journal of pain and symptom management, 34(6), 628–638.

Lyons, K.M., Christopoulos, A., & Brock, T.P. (2020). Sustainable pharmacy education in the time of COVID-19. American journal of pharmaceutical education, 84(6)

Marshall, L.L., Allison, A., Nykamp, D., & Lanke, S. (2008). Perceived stress and quality of life among doctor of pharmacy students. American journal of pharmaceutical education, 72(6)

McCormack, Z., Gilbert, J.L., Ott, C., & Plake, K.S. (2018). Mental health first aid training among pharmacy and other university students and its impact on stigma toward mental illness. Currents in Pharmacy Teaching and Learning, 10(10), 1342-1347

McLafferty, M., Lapsley, C.R., Ennis, E., Armour, C., Murphy, S., Bunting, B.P., Bjourson, A.J., Murray, E.K., & O'Neill, S.M. (2017). Mental health, behavioural problems and treatment seeking among students commencing university in Northern Ireland. PLoS One, 12(12),

Moutinho, I.L.D., Lucchetti, A.L.G., da Silva Ezequiel, O., & Lucchetti, G. (2019). Mental health and quality of life of Brazilian medical students: Incidence, prevalence, and associated factors within two years of follow-up. Psychiatry Research, 274, 306-312

Nahar, V.K., Davis, R.E., Dunn, C., Layman, B., Johnson, E.C., Dascanio, J.J., Johnson, J.W., & Sharma, M. (2019). The prevalence and demographic correlates of stress, anxiety, and depression among veterinary students in the Southeastern United States. Research in veterinary science, 125, 370-373.

Nahas, A.R.M.F., Elkalmi, R.M., Al-Shami, A.M., & Elsayed, T.M. (2019). Prevalence of depression among health sciences students: Findings from a public university in Malaysia. Journal of pharmacy & bioallied sciences, 11(2), 170

Narakornwit, W., Pongmesa, T., Srisuwan, C., Srimai, N., Pinphet, P., & Sakdikul, S. (2019). Quality of life and student life satisfaction among undergraduate pharmacy students at a public university in Central Thailand. Science, Engineering and Health Studies (FORMER NAME 'SILPAKORN UNIVERSITY SCIENCE AND TECHNOLOGY JOURNAL’), 13(1), 8-19

Opoku-Acheampong, A., Kretchy, I. A., Acheampong, F., Afrane, B.A., Ashong, S., Tamakloe, B., & Nyarko, A.K. (2017). Perceived stress and quality of life of pharmacy students in University of Ghana. BMC research notes, 10(1), 115

Paro, H.B., Morales, N.M., Silva, C.H., Rezende, C.H., Pinto, R.M., Morales, R.R., Mendonça, T.M., & Prado, M.M. (2010). Health-related quality of life of medical students. Medical education, 44(3), 227–235.

Raosoft Inc. (2004). Sample size calculator (online). Available from:

Ribeiro, I.J., Pereira, R., Freire, I.V., de Oliveira, B.G., Casotti, C.A., & Boery, E.N. (2018). Stress and quality of life among university students: A systematic literature review. Health Professions Education, 4(2), 70-77

Sandhu, S.S., Ismail, N.H., & Rampal, K.G. (2015). The Malay Version of the Perceived Stress Scale (PSS)-10 is a Reliable and Valid Measure for Stress among Nurses in Malaysia. The Malaysian journal of medical sciences : MJMS, 22(6), 26-31. Available from:

Schlesselman, L.S., Cain, J., & DiVall, M. (2020). Improving and Restoring the Well-being and Resilience of Pharmacy Students during a Pandemic. American journal of pharmaceutical education, 84(6)

Seo, E.J., Ahn, J.-A., Hayman, L.L., & Kim, C.-J. (2018). The association between perceived stress and quality of life in university students: the parallel mediating role of depressive symptoms and health-promoting behaviors. Asian nursing research, 12(3), 190-196

Shamsuddin, K., Fadzil, F., Ismail, W.S., Shah, S.A., Omar, K., Muhammad, N.A., Jaffar, A., Ismail, A., & Mahadevan, R. (2013). Correlates of depression, anxiety and stress among Malaysian university students. Asian journal of psychiatry, 6(4), 318–323.

Sherina, M.S., Arroll, B., & Goodyear-Smith, F. (2012). Criterion validity of the PHQ-9 (Malay version) in a primary care clinic in Malaysia. The Medical Journal of Malaysia, 67(3), 309-315

Silva, R.G., & Figueiredo-Braga, M. (2018). Evaluation of the relationships among happiness, stress, anxiety, and depression in pharmacy students. Currents in Pharmacy Teaching and Learning, 10(7), 903-910

Unni, E.J., Madrid, L., Oderda, G., & Saokaew, S. (2015). Quality of life of pharmacy students in the United States. Currents in Pharmacy Teaching and Learning, 7(6), 753-763

Vallejo, M.A., Vallejo-Slocker, L., Fernández-Abascal, E.G., & Mañanes, G. (2018). Determining factors for stress perception assessed with the Perceived Stress Scale (PSS-4) in Spanish and other European samples. Frontiers in psychology, 9, 37




How to Cite

Blebil, A. ., Dujaili, J., Haider Mohammed, A. ., Cheong, C. M. ., & Hoo, Y. . (2021). RESEARCH ARTICLE: The effect of stress and depression on quality of life of pharmacy students in Malaysia. Pharmacy Education, 21, p. 323–333.



Research Article