Perceived stress and body image perception as correlates of eating disorders among pharmacy students in a Nigerian university: A cross-sectional survey
DOI:
https://doi.org/10.46542/pe.2025.251.105114Keywords:
Body image, Eating disorder, Pharmacy student, Stress, UniversityAbstract
Background: High perceived stress and concerns about body image can potentially trigger eating disorders (ED) among university students. This study aimed to investigate the relationship between EDs and perceived stress and body image among pharmacy students in a Nigerian public university.
Methods: A descriptive cross-sectional study was conducted among all undergraduate pharmacy students in a Nigerian public university. The Body Shape Questionnaire, Eating Attitudes Test, and Perceived Stress Scale were used for data collection. Data were analysed using descriptive statistics, chi-square test and Pearson correlation tests. The level of significance was set at p < 0.05.
Results: Out of the 417 respondents, more than half were male (52.3%) and aged 21-25 years (53.7%). About 62.6% of the students had a high risk of ED. Although most students (94.5%) had no body shape concern, 87.3% were moderately stressed. Body image perception (r = 0.650, p < 0.001) and perceived stress (r = 0.151, p = 0.002) had a positive correlation with the risk of ED.
Conclusion: Higher stress levels and more negative body image perceptions were associated with a higher risk of ED among pharmacy students. Appropriate interventions to reduce stress levels and address body image concerns among pharmacy students are recommended.
References
Al-Awwad, N. J., Al-Sayyed, H. F., Zeinah, Z. A., & Tayyem, R. F. (2021). Dietary and lifestyle habits among university students at different academic years. Clinical Nutrition ESPEN, 44, 236–242. https://doi.org/10.1016/j.clnesp.2021.06.010
Al Banna, M. H., Dewan, M. F., Tariq, M. R., Sayeed, A., Kundu, S., Disu, T. R., … Khan, M. S. I. (2021). Prevalence and determinants of eating disorder risk among Bangladeshi public university students: A cross-sectional study. Health Psychology Research, 9(1). https://doi.org/10.52965/001C.24837
Al Rasheed, F., Naqvi, A. A., Ahmad, R., & Ahmad, N. (2017). Academic stress and prevalence of stress-related self-medication among undergraduate female students of health and non-health cluster colleges of a public sector university in Dammam, Saudi Arabia. Journal of Pharmacy and Bioallied Sciences, 9(4), 251–258. https://doi.org/10.4103/jpbs.jpbs_189_17
Alhazmi, A. H., & Al Johani, A. (2019). Prevalence and associated factors of eating disorders among students in Taiba University, Saudi Arabia: A cross sectional study. Malaysian Journal of Public Health Medicine, 19(1), 172–176. https://doi.org/10.37268/mjphm/vol.19/no.1/art.80
Alshagga, M.A., Nasir, N. Z. M., Behzadnia, A., Jasamai, M., Al-Absi, A., & Al-Dubai, S. A. R.. (2015). Perceived stress and sources of stress among pharmacy students in Malaysian public and private universities: A comparative study. Pharmacy Education, 15(1), 64–68.
American Psychological Association. (2024). What are Eating Disorders? https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders
Assari, S. (2018). Financial distress, anxiety, depression, and suicide among American college students. International Journal of Behavioral Sciences, 12(2), 84–90. https://www.behavsci.ir/article_82783.html
Auwal, F. I., Tukur, Z. A., Abdu-Aguye, S. N., & Ma’aji, H. U. (2021). Perceived stress levels and stressors in undergraduate pharmacy students’ at a Nigerian tertiary institution. Nigerian Journal of Pharmaceutical Research, 16(2), 23–30. https://doi.org/10.4314/njpr.v16i2.3S
Azzouzi, N., Ahid, S., Bragazzi, N. L., Berhili, N., Aarab, C., Aalouane, R., … Rammouz, I. (2019). Eating disorders among moroccan medical students: Cognition and behavior. Psychology Research and Behavior Management, 12, 129–135. https://doi.org/10.2147/PRBM.S165114
Baik, C., Larcombe, W., & Brooker, A. (2019). How universities can enhance student mental wellbeing: The student perspective. Higher Education Research and Development, 38(4), 674–687. https://doi.org/10.1080/07294360.2019.1576596
Becker, A. E., Fay, K. E., Agnew-Blais, J., Khan, A. N., Striegel-Moore, R. H., & Gilman, S. E. (2011). Social network media exposure and adolescent eating pathology in Fiji. The British Journal of Psychiatry: The Journal of Mental Science, 198(1), 43–50. https://doi.org/10.1192/bjp.bp.110.078675
Campo-Arias, A., & Villamil-Vargas, M. (2012). Risk of eating behavior disorder among medical students in Colombia [in Spanish]. Revista Colombiana de Psiquiatría, 41(2), 328–339. https://doi.org/10.1016/S0034-7450(14)60008-1
Chan, Y. L., Samy, A. L., Tong, W. T., Islam, M. A., & Low, W. Y. (2020). Eating disorder among Malaysian university students and its associated factors. Asia-Pacific Journal of Public Health, 32(6–7), 334–339. https://doi.org/10.1177/1010539520947879
Couturier, J. L., & Lock, J. (2006). Denial and minimization in adolescents with anorexia nervosa. The International Journal of Eating Disorders, 39(3), 212–216. https://doi.org/10.1002/eat.20241
de Matos, A. P., Rodrigues, P. R. M., Fonseca, L. B., Ferreira, M. G., & Muraro, A. P. (2021). Prevalence of disordered eating behaviors and associated factors in Brazilian university students. Nutrition and Health, 27(2), 231–241. https://doi.org/10.1177/0260106020971136
Dial, L. A., DeNardo, F. A., Fevrier, B., Morgan, A. L., Du, C., Tucker, R. M., … Ludy, M. J. (2023). Comparing mental health and well-being of US undergraduate and graduate students during the early stages of the COVID-19 pandemic. Journal of American College Health, 71(9), 2775–2785. https://doi.org/10.1080/07448481.2021.1996372
Fajardo-Gutiérrez, A. (2017). Measurement in epidemiology: Prevalence, incidence, risk, impact measures. Revista Alergia Mexico, 64(1), 109–120. https://doi.org/10.29262/ram.v64i1.252
Fernandes, H. M., Soler, P., Monteiro, D., Cid, L., & Novaes, J. (2023). Psychometric properties of different versions of the body shape questionnaire in female aesthetic patients. Healthcare, 11(18), 2590. https://doi.org/10.3390/healthcare11182590
Gailledrat, L., Rousselet, M., Venisse, J.-L., Lambert, S., Rocher, B., Remaud, M., … Grall-Bronnec, M. (2016). Marked body shape concerns in female patients suffering from rating disorders: Relevance of a clinical sub-group. PLOS ONE, 11(10), e0165232. https://doi.org/10.1371/journal.pone.0165232
Ghafouri, K. J., Qadhi, A. H., Ghaith, M. M., Azhar, W. F., Azzeh, F. S., & Habibullah, M. M. (2021). Eating disorders amongst adolescents in Makkah: Effects of stress and smoking. Medical Science, 25(110), 767–775. https://www.discoveryjournals.org/medicalscience/current_issue/v25/n110/A3.htm
Ghamri, R. A., Alahmari, A. M., Alghamdi, L. S., Alamoudi, S. F., & Barashid, M. M. (2022). Prevalence and predictors of eating disorders: A cross-sectional survey of medical students at King Abdul-Aziz University, Jeddah. Pakistan Journal of Medical Sciences, 38(6), 1633–1638. https://doi.org/10.12669/pjms.38.6.5033
Hoteit, M., Mohsen, H., Bookari, K., Moussa, G., Jurdi, N., & Yazbeck, N. (2022). Prevalence, correlates, and gender disparities related to eating disordered behaviors among health science students and healthcare practitioners in Lebanon: Findings of a national cross sectional study. Frontiers in Nutrition, 9, 956310. https://doi.org/10.3389/fnut.2022.956310
Karir, S., Mohanan, S., & Jacob, G. P. (2023). Eating disorders and its association with body image perception and stress among medical students of a tertiary care centre in North Kerala. International Journal of Academic Medicine and Pharmacy, 5(6), 1121–1124. https://doi.org/10.47009/jamp.2023.5.6.229
Kugu, N., Akyuz, G., Dogan, O., Ersan, E., & Izgic, F. (2006). The prevalence of eating disorders among university students and the relationship with some individual characteristics. Australian and New Zealand Journal of Psychiatry, 40(2), 129–135. https://doi.org/10.1111/j.1440-1614.2006.01759.x
Lipson, S. K., & Sonneville, K. R. (2017). Eating disorder symptoms among undergraduate and graduate students at 12 US colleges and universities. Eating Behaviors, 24, 81–88. https://doi.org/10.1016/j.eatbeh.2016.12.003
Madsen, S. K., Bohon, C., & Feusner, J. D. (2013). Visual processing in anorexia nervosa and body dysmorphic disorder: Similarities, differences, and future research directions. Journal of Psychiatric Research, 47(10), 1483–1491. https://doi.org/10.1016/j.jpsychires.2013.06.003
Manaf, N. A., Saravanan, C., & Zuhrah, B. (2016). The prevalence and inter-relationship of negative body image perception, depression and susceptibility to eating disorders among female medical undergraduate students. Journal of Clinical and Diagnostic Research, 10(3), VC01‒VC04. https://doi.org/10.7860/JCDR/2016/16678.7341
Masilamani, R., Aung, M. M. T., Othman, H., Abu Bakar, A., Keat, T. C., Ravichandran, S., … Jagajarantan, S. P. (2019). Stress, stressors and coping strategies among university nursing students. Malaysian Journal of Public Health Medicine, 19(2), 20–28. https://doi.org/10.37268/mjphm/vol.19/no.2/art.168
Naeimi, A. F., Haghighian, H. K., Gargari, B. P., Alizadeh, M., & Rouzitalab, T. (2016). Eating disorders risk and its relation to self-esteem and body image in Iranian university students of medical sciences. Eating and Weight Disorders, 21(4), 597–605. https://doi.org/10.1007/s40519-016-0283-7
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, 1–7. https://doi.org/10.1186/s13104-017-2439-6
Osian, E. A., Ehwarieme, T. A., & Igbinoba, O. (2020). Knowledge, attitude and utilization of school health services among senior secondary school students in Egor local government area, Benin City, Edo State. International Journal of Tropical Disease & Health, 1–9. https://doi.org/10.9734/ijtdh/2020/v41i1230336
Pengpid, S., Peltzer, K., & Ahsan, G. U. (2015). Risk of eating disorders among University students in Bangladesh. International Journal of Adolescent Medicine and Health, 27(1), 93–100. https://doi.org/10.1515/ijamh-2014-0013
Qian, J., Wu, Y., Liu, F., Zhu, Y., Jin, H., Zhang, H., … Yu, D. (2022). An update on the prevalence of eating disorders in the general population: a systematic review and meta-analysis. Eating and Weight Disorders, 27(2), 415–428. https://doi.org/10.1007/s40519-021-01162-z
Rasolofotsialonina, N. H., Razafilisy J. L., Rahanitrandrasana, E. O., Zafisoa, M. G., Raobelle, E. N. A., Rajaonarison, B. H., & Raharivelo, A. (2024). Assessment of the risk of eating disorders among medical students in Antananarivo, Madagascar. World Journal of Advanced Research and Reviews, 22(1), 351–357. https://doi.org/10.30574/wjarr.2024.22.1.1044
Rauof, M., Ebrahimi, H., Jafarabadi, M. A., Malek, A., & Kheiroddin, J. B. (2015). Prevalence of eating disorders among adolescents in the northwest of Iran. Iranian Red Crescent Medical Journal, 17(10), e19331. https://doi.org/10.5812/ircmj.19331
Safer, M., Zemni, I., Mili, M., Ghanaia, H. Ben, Salem, K. Ben, Zaafrane, F., & Abdelaziz, A. Ben. (2020). Eating disorders: Prevalence and associated factors among health occupation students in monastir university (Tunisia). Tunisie Medicale, 98(12), 895–912. https://pubmed.ncbi.nlm.nih.gov/33479992/
Sahir, K., Tur, R. E., Husnnain, R., Hafsa, S., Muhamad, S., Naureen, S., Zia, U.M., Noman, A., Khalid, H., Muhammad, T.K., Amer H.K., & Fahad, S.(2017). It’s not just a “female issue”: Eating attitudes and behaviors of Pakistani male and female pharmacy students. Russian Open Medical Journal, 6(4), 406. https://doi.org/10.15275/rusomj.2017.0406
Seto, M., Usukura, H., Kunii, Y., Hamaie, Y., Kodama, E. N., Makino, Y., Kinouchi, Y., Ito, C., Ikeda, T., & Tomita, H. (2023). Mental health problems among university students under the prolonged COVID-19 pandemic in Japan: A repeated cross-sectional survey. Tohoku Journal of Experimental Medicine, 260(1), 1–11. https://doi.org/10.1620/tjem.2023.J012
Smink, F. R. E., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: incidence, prevalence and mortality rates. Current Psychiatry Reports, 14(4), 406–414. https://doi.org/10.1007/s11920-012-0282-y
Sohail, N. (2013). Stress and academic performance among medical students. Journal of the College of Physicians and Surgeons Pakistan, 23(1), 67–71. https://pubmed.ncbi.nlm.nih.gov/23286627/
Suhail, K., & Zaib-u-Nisa. (2002). Prevalence of eating disorders in Pakistan: Relationship with depression and body shape. Eating and Weight Disorders: EWD, 7(2), 131–138. https://doi.org/10.1007/BF03354439
Tavolaccci, M. P., Grigioni, S., Richard, L., Meyrignac, G., Déchelotte, P., & Ladner, J. (2015). Eating disorders and behaviors among college students. Journal of Nutrition Education and Behavior, 47, 412–420. https://doi.org/10.1016/j.jneb.2015.06.009
Tavolacci, M.-P., Déchelotte, P., & Ladner, J. (2020). Eating Disorders among college students in France: Characteristics, help-and care-seeking. International Journal of Environmental Research and Public Health, 17(16), 5914. https://doi.org/10.3390/ijerph17165914
Vijayalakshmi, P., Thimmaiah, R., Reddy, S. S. N., Kathyayani, B. V., Gandhi, S., & BadaMath, S. (2017). Gender differences in body mass index, body weight perception, weight satisfaction, disordered eating and Weight control strategies among Indian Medical and Nursing Undergraduates. Investigacion Y Educacion En Enfermeria, 35(3), 276–284. https://doi.org/10.17533/udea.iee.v35n3a04
Warren, C. S., Holland, S., Billings, H., & Parker, A. (2012). The relationships between fat talk, body dissatisfaction, and drive for thinness: Perceived stress as a moderator. Body Image, 9(3), 358–364. https://doi.org/10.1016/j.bodyim.2012.03.008
WHO. (2022). Mental disorders. Retrieved June 18, 2024, from https://www.who.int/news-room/fact-sheets/detail/mental-disorders
Yan, J., Su, H., & Li, C. (2022). Effect of body dissatisfaction on binge eating behavior of Chinese university students: A moderated mediation model. Frontiers in Psychology, 13(November). https://doi.org/10.3389/fpsyg.2022.995301
Zainal, N. H., Romziman, N. S., Aminuddin, B. A., Syed Idros, S. A. K., & Salem Wajih, W. A. (2021). The relationship of body image perception, self-esteem and academic performance in University of Cyberjaya (UoC) undergraduates. Malaysian Journal of Medicine and Health Sciences, 17, 33–39. https://medic.upm.edu.my/upload/dokumen/2021122719112906_2021_0401.pdf