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Investigación y Educación en Enfermería

Print version ISSN 0120-5307On-line version ISSN 2216-0280

Invest. educ. enferm vol.37 no.3 Medellín Sept. 2019 

Original article

State of Mental Health and Associated Factors in Nursing Students from Southeastern Iran

Estado de salud mental y factores asociados en estudiantes de enfermería del suroeste de Irán

Estado de saúde mental e fatores associados em estudantes de enfermagem do sudoeste do Irã

Zinat Mohebbi1 

Giti Setoodeh2 

Camelia Torabizadeh3 

Masoume Rambod4 

1 Ph.D. Department of Medical Surgical Nursing, Shiraz University of Medical Sciences, Shiraz, Iran. Email: Corresponding author.

2 Ph.D. Candidate. Department of Psychiatric Nursing, Shiraz University of Medical Sciences, Shiraz, Iran. Email:

3 Ph.D. Department of Medical Surgical Nursing, Shiraz University of Medical Sciences, Shiraz, Iran.

4 Ph.D. Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.



To evaluate the state of mental health and its relation with associated factors among nursing students.


A cross-sectional study was conducted with 130 students from the Nursing and Midwifery College affiliated to the University of Medical Sciences of Shiraz (Iran). Data was collected through a document that included information on the demographic characteristics, the mean grades of the practical assignments and of the total (practical and theoretical assignments), and the Goldberg Health Questionnaire (GHQ-28) that measures symptoms grouped into four dimensions (somatic symptoms, anxiety and insomnia, social dysfunction, and depression).


Most of the participants (65.1%) were women; 5.3% were between 21 and 22 years of age, 84.5% were single, and 33.3% were in the sixth semester; 68.5% of the students had problems with mental health. By dimensions of the GHQ-28, it was found that 7.7% had somatic symptoms, 13.8% symptoms of anxiety and sleep disorders, 52.3% social dysfunction, and 6.2% depression. Males had a higher score of depression than females, and being single was related with higher scores of physical symptoms, anxiety and insomnia, and depression, compared with those who were married. An inverse relationship was found between the GHQ-28 average score and the semester, the grade in practical assignments, and the total grade for physical symptoms and anxiety and insomnia.


There is a high proportion of nursing students with suspected mental health disorder. Some demographic and academic factors are related with the mental health of students and must be kept in mind by the institutions training future nurses.

Descriptors: students, nursing; mental health; depression; anxiety; sleep wake disorders; confounding factors (epidemiology); surveys and questionnaires.



Evaluar el estado de salud mental y su relación con factores asociados entre los estudiantes de enfermería.


Se realizó un estudio de corte transversal con 130 estudiantes del Colegio de Enfermería y Partería afiliado a la Universidad de Ciencias Médicas de Shiraz (Irán). Para la toma de los datos se empleó un formulario que incluía información sobre las características demográficas, los promedios de calificación de las asignaturas prácticas y del total (asignaturas prácticas más teóricas), y el Cuestionario de Salud Goldberg (GHQ-28) que mide síntomas agrupados en cuatro dimensiones (síntomas somáticos, ansiedad e insomnio, disfunción social, y depresión).


La mayoría de los participantes (65.1%) fueron mujeres; el 5.3% tenía entre 21 y 22 años; solteros, el 84.5% y el 33.3% estudiaba en el sexto semestre. El 68.5% de los estudiantes tenía problemas con la salud mental. Por dimensiones del GHQ-28, se encontró que el 7.7% tenía síntomas somáticos; 13.8%, síntomas de ansiedad y trastornos del sueño; 52.3%, disfunción social y 6.2% depresión. El sexo masculino tuvo mayor puntaje de depresión que las mujeres, y el estado civil soltero se relacionó con mayores puntajes de síntomas físicos, ansiedad e insomnio y depresión, comparado con los casados. Se encontró una relación inversa entre el promedio del puntaje del GHQ-28 y el semestre, la calificación en las asignaturas prácticas y la calificación total para síntomas físicos y ansiedad e insomnio.


Es alta la proporción de estudiantes de enfermería con sospecha de trastorno de la salud mental. Algunos factores demográficos y académicos están relacionados con su salud mental y deben ser tenidos en cuenta por las instituciones formadoras de los futuros enfermeros.

Descriptores: estudiantes de enfermería; salud mental; depresión; ansiedad; trastornos del sueño-vigilia; factores de confusión (epidemiología); encuestas y cuestionarios.



Avaliar o estado de saúde mental e sua relação com fatores associados entre os estudantes de enfermagem.


Se realizou um estudo de corte transversal com 130 estudantes do Colégio de Enfermagem e Parteira afiliada à Universidade de Ciências Médicas de Shiraz (Irã). Para a toma dos dados se empregou um formulário que incluía informação sobre as características demográficas, as médias de qualificação das matérias práticas e do total (matérias práticas mais teóricas), e o Questionário de Saúde Goldberg (GHQ-28) que mede sintomas agrupados em quatro dimensões (sintomas somáticos, ansiedade e insônia, disfunção social, e depressão).


A maioria dos participantes (65.1%) eram mulheres; 5.3% tinham entre 21 e 22 anos, eram solteiros (84.5%) e o 33.3% estudavam no sexto semestre. 68.5% dos estudantes tinham problemas com a saúde mental. Por dimensões de GHQ-28, se encontrou que 7.7% tinham sintomas somáticos, 13.8% sintomas de ansiedade e transtornos do sono, 52.3% disfunção social e 6.2% depressão. O sexo masculino teve maior pontuação de depressão que as mulheres, e o estado civil solteiro se relacionou com maiores pontuações de sintomas físicos, ansiedade e insônia e depressão, comparado com os casados. Se encontrou uma relação inversa entre a média da pontuação de GHQ-28 e o semestre, a qualificação nas matérias práticas e a qualificação total para sintomas físicos e ansiedade e insônia.


É alta a proporção de estudantes de enfermagem com suspeita de transtorno da saúde mental. Alguns fatores demográficos e acadêmicos estão relacionados com a saúde mental dos estudantes e devem ser tidos em conta pelas instituições formadoras dos futuros enfermeiros.

Descritores: estudantes de enfermagem; saúde mental; depressão; ansiedade; transtornos do sono-vigília; fatores de confusão (epidemiologia); inquéritos e questionários.


Mental health is defined as a state of well-being in which every individuals realizes theirhis or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and areis able to make a contributeion to theirher or his community.1 According to Kamau,2 a person who is enjoying the mental health is one who is away from anxiety and disability symptoms, can could make good communicate wellion with others, and is also able to face life’s the pressure of life. According to another theory, the mental health is “the adaptation of individuals with theirhis/her surrounding world to the possible extent in such a way that, it causes the happiness and useful and effective enjoyment completely”.3) Actually, a person with good who possesses the mental health has a is having the better function and quality of life, compareding with others.4 Mental health is a subject which has been studied vastlylargely among students during recent years. The relative hHealth problems are numerous and increaseing among students.5 The importance of studying the mental health in universities is valuable because it could have direct relation with the educational progress of students.6 Student life, non-acquaintance with the new educational environment, remaining away from family, being uninterested with the educational field, incompatibility with others in the student life environment, socio-economical problems, and the lack of welfare facilities are among the causes creating mental problems and inconveniences and, finally, causes the educational subsidence.7,8

The prevalence of mental disorder among students has been addressedattended by researchers. In the research carried out researches, this rate has been reported atas 50.0% and 30.0% among students from of USA universities in the USA and Europe universities, respectively.8,9 According to such reports, 79.2% of students from African universities and 43.2% from Asian universities also havepossess the symptoms of mental disorder.6,10) Also, according to a study conductedcarried out study, the rate of depression disorder in the students fromof Iranian universities is reported atto be 28.04%.11) Considering the importance of the mental health of students, specially nursing students, due to the nature of this educational field and because they have having direct contact with patients and their relativesattendants and other personnel of health staffteam and that no research has been carried out in this respect among nursing students fromof Shiraz Uuniversity and also paying attention to the fact that, general health is such an index that should be measured in various individuals of a society during different periods of life; therefore, researchers decided to carry out a study with the aim to determine the mental health status among such students. This will be the first step to promote the level their mental health, so that students with this kind having the problem of of problems would be identified for diagnosis and treatment and, in this way, complications in their mental health state and poor educational performance would be prevented.


A descriptive, cross-sectional study was conducteddone between 2016 andto 2017. The variable of mental health of undergraduateB.Sc. nursing students was evaluated in this study. All undergraduateB.Sc. nursing students studying at the Nursing and Midwifery College affiliatedrelated to the Shiraz University of Medical Sciences comprised formed the research population and all accessible students who had propensity of participating in the study and signed the informed consent were evaluated. Of the 176 students that were selected, only 130 delivered the questionnaire completely filled out to the researchers. Data collecting tools were consisteding of demographic characteristics (sex, age, marriage status), academic characteristics (semester of studyeducational term??? Semester?, training score and total average and Goldberg Health Questionnaire (GHQ-28) tofor measureing the general health. The training score means the gradescore of practical lessons and the average ismeans the total average of theoreticaly and practical assignmentslessons. This questionnaire includes 28 multiple choice questions of multiple choices which were used by Goldberg and Hiler in the year 1972 in order to recognize the mild mental disorder.12 The questions inof this questionnaire includes four4 levels, namely, “much lowervery lesser than regular level with the score of zero”, “lower lesser than regular level with the score of one”, “at the regular level with the score of two” and “more than regular level with the score of three” and its score range will be from 0zero to 84. Each dimension consists of seven7 questions and the maximum score in each dimension is 21 and in totally, there are 84 scores and the highermore score specifies the lower general health.13 This tool included four4 sub-scales in social function, anxiety and sleep disorder, depression, and disorder in physical health. The cutoff point of 23.0 and 14.0 was considered tofor the determineation of mental health disorder and for the sub-scale, respectively. The validity as well as reliability of the Persian version of questionnaire was confirmed in various studies.14,15 The reliability coefficient for the whole GHQ was 0.96 and for the sub-scales of depression, anxiety, physical and social disorder, it was determined as 0.94, 0.90, 0.89, and 0.7, respectively.16) The amount of Cronbachʼs alpha in this research was calculated atto be 0.85. Data Ccollected data were analyzed by using SPSS version 23 software, with taking the help fromof descriptive statistic tests, independent tests, Kruskal-Wallis H, Mann-Whitney U, and One Way Analysis of Variance. The statistical significance significant level for the tests was 0.05.


In this study, most of the participants (65.1%) were women, with mean and the age ranging limit fromwas 21 to -22 years (55.3%). Most of students (84.5%) were single and 33.3% of them were in the studying at 6th term semester. The maximum training score of the participants was 19.0 and the minimum was 15.5; and the mean of the total average of all the whole students was 15.62±1.62. 68.5% of them were doubtful to mental disorder. In this investigation, only 30.0% of students were healthy and 68.5% of them were suspected of suffering from doubtful about mental health disorder (Table 1). By Eevaluating each of questionnaire domain, it was specified that, 7.7%, 13.8%, 52.3%, and 6.2% of the individuals suffered from disorders in the physical dimension, symptoms of anxiety and sleep disorder, disorder in social function, and symptoms of depression symptoms, respectively. The most prevalent disorder was observed in social function (Table 1).

Table 1 Frequency of healthy individuals and those suspected of suffering from mental health disorder (n = 130) 

Table 2 shows the average scores of the total and by domains of the GHQ-28, according to demographic variables. Males had higher average scores, exclusively in the domain of depression; and those who were single in the scale total and in the domains of physical symptoms, anxiety and insomnia, and depression. Age was not significantly related with the scale score in any domain or with the total.

Table 2 Mean and standard deviation of the scores of four 4 domains of Mmental Hhealth according to demographic characteristics 

For the academic variables, the average of the GHQ-28 noted that the significant and inverse relation between educational semester and the score of the depression domain could be mentioned as the other results of this research in such a way that students in higher semesters obtained a lower depression score. The training score showed a significant and also inverse relationship with the global score, as well as the score of physical symptoms and anxiety domains;, meaning that, those who had a better training scores obtained a lower score of mental health, physical symptoms, and anxiety. The total average score had a borderline statistical significancet with the scores of the total scale and its domains (Table 3).

Table 3 Mean and standard deviation of the scores of four domains of mental health according to the educational semester, training score, and total average 


It was specified iIn this study that, only 30.0% of students hadwere enjoying the good mental health and the total score average of mental health of the Shiraz nursing students was reported atto be 29.74±10.45. A study in China in this respect in the year 2012 showed the general health of students atto be 22.9%.17 A study in Sweden reported the prevalence of depression disorder among first- year nursing students atto be 16.4%18 and 24.0% of medical students from the USA were suffering from depression.19 According to a five- years’ prospective study in England, it was specified that, 66.2% of medical students were suffering from at least minimum one of the indexes of general health status. Also, the general health status of the first- year students was accounted as to be a criterion for anticipating their mental health status during the coming years.20 Considering the obtained rate of mental health obtained, using the psychological and therapeutic methods, it seems to be necessary to improve the general health status of nursing students.

The results showed that, social function disorder (52.3%) was the most prevalent (52.3%) problem of students, which ishas similarity towith previous studies20,21 ; therebyso it seems that, more attention should be paid to studying the social function of students during student consultations.Students could be encouraged to have the best function, causing the support of their self-reliance by arranging the consultation and self-adjustment classes. Using the educational guides to support the social skills of students also seems to be necessary. The dimension of physical symptoms in the GHQ is an indication of the chance for individuals to suffer from physical illness.22 In this study, the mean of 6.58±4.29 with 7.7% was obtained in this dimension. In this respect, Dalal and Bala23 showed athe mean of 23.7%.

In the depression domain, the lowest percentage (6.2%) with the mean of 3.66±4.69 was obtained. This dimension was mentioned as 2.7% in previous studies.23 The American National Institute of Mental Health reported the rate of depression of students atto be 30.0%.24 From the view point of the anxiety domain in our study, the rate of 13.8% with the mean of 6.96±5.49 was obtained. This index has been reported in another studies atto be 53.3%.23 Suitable educational environment, good contact with professors and reciprocal understanding of students and professors could be effective in reducing such condition. Given thatSince anxiety could affect the other important aspects of life, causing disorder in the social function, therefore paying attention to suchit is of great importance.

In this study the score of depression dimension of male students was higher than in female students. This is the case that, mMost studies either did not obtain any statistical significant relation between womenwoman and menman25) or obtained significant statistical difference from the point of view point of sex among students using alcohol, drugs, or tobacco.26 It seems that, this lack of dissimilarity is due to the existence of various reasons, like differentiating of cut-off point among sub-divisions in the present study, that nursing students were only the under study group while in the mentions studies.

The relation between maritalmarriage status andwith the score of general health and sub-divisions of depression, physical symptoms, and anxiety was statistically significant in such a way that, married peoplepersons obtained better scores. In this respect, these findings were had similarity to with research carried out in researches at Mazandaran, Zahedan, Jiroft, and Iran University of Medical Sciences,19,20 but does are not have similarity towith some studies.24 Probably tThis variation is likely due to the difference between the groups under studied groups because none of the studies recent mentioned studies have been carried out within case of nursing students. The significant relation between semester of studyeducational term and the score of the depression dimension could be mentioned as the other results of this research soin such a way that, the students fromof higher semestersterms obtained a lower depression score. In this respect, the results of the study byof Dalal and Bala showed that, the general health of students fromof higher semestersclasses is better than those in that of lower semestersclasses.23 Davidson also reported achieved this result that, anxiety among beginner students is more than that of seniors ones.27) It seems that, nursing students during the initial semestersfirst terms, due to not being aquainted non-acquaintance with the ward and withalso the nature of their educational field (most of the subjects are to be covered at the hospital and therapeutic centers), will be adapted towith the environment during the higher semestersterms and obtain a better mentality health.

The training score showed statistically significant relation with the score of mental health, as well as the score of the physical symptoms and anxiety sub-divisions, meaning that, those who had a better training scores of training obtained a better scores inof mental health, physical symptoms, and anxiety. In this respect, the results of this study werehad similarity towith the results fromof other studies.21,23,25 In this study, the average score did not showed no statistically significant relation with the scores of mental health and its sub-divisions, but some of the studiesabove mentioned studies showed reverse statistical relation between the mean score andwith the score of general health, meaning that, highermore the mean score indicates lower lesser will be the score of general health so that the student’s mental status of the student was better.

The conclusion of this research reveals indicates that, the doubtful cases suspected of general health disorder among students fromof Shiraz University of Medical Sciences are comparatively high. Although the GHQ-28 cannot prove the physical or mental problems of students definitely, itbut recognizes the students exposeding to risk to some extent. University students report educational-related and general stressors in Iran.28 This study also found that some demographic and academic factors are related with the mental health of the students, this is why they should be kept in mind by institutions training future nurses.

The limitations of this research could also interfere in explaining the results;. Rrefusaling by some students to answer some questions and the smalllow sample size are among the limitations of this study. Nonexistence of motivation or desire tofor answering the research questionnaire is the current problems of such studies. It seems that, carrying out the longitudinal researches with a large sample size and considering the interfering variables and controlling the confounding variables is the mostmore suitable choice to reach the better results. Therefore, more specific evaluations to study this disorder could also determine the cause of the increaseincrement in of this index compareding with other carried out studies carried out. Of course, by recognizing such students and arranging consultation classes with psychologists and psychiatrists, the risky factors could be reduced in these students.


The authors would like to thank the nursing students for their sincere cooperation in performing this research.


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Conflicts of interest: none.

How to cite this article: Mohebbi Z, Setoodeh G, Torabizadeh C, Rambod M. State of Mental Health and Associated Factors in Nursing Students from Southeastern Iran. Invest. Educ. Enferm. 2019; 37(3):e04.

Funding: This study was financially supported by the Research Vice-chancellor of SUMS.

Received: November 20, 2018; Accepted: September 30, 2019

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