Prevalence of stress and associated Factors among students in Ethiopia: A systematic review and meta-analysis

Anmut Endalkachew Bezie ^1* Giziew Abere ² Girum Tareke Zewude ³ Belay Desye ⁴ Chala Daba ⁴ Eyob Tilahun Abeje ⁵ Awoke Keleb ⁴

• ¹ Department of Occupational Health and Safety, College of Medicine and Health Sciences, Wollo University., Dessie, Ethiopia
• ² Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara Region, Ethiopia
• ³ Wollo University, Dessie, Amhara, Ethiopia
• ⁴ Department of Environmental Health, College of Medicine and Health Science, Wollo University, Dessie, Amhara, Ethiopia
• ⁵ Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia

Stress is an increasing public health issue among the student population worldwide. This stress can significantly affect their academic performance, mental health, and overall well-being. As a result, we conducted a systematic review and meta-analysis to determine the pooled prevalence and associated factors of stress among students in Ethiopia.Methods: An extensive search of electronic databases such as PubMed, Google Scholar, Semantic Scholar, HINARI, and Science Direct, and Google manual search were used for studies published from 1998 to 2024. The preferred PRISMA guideline was used. To extract data, Microsoft Excel 16 and to analyze STATA 17 software were used. The JBI quality assessment tool was used. To estimate the pooled prevalence of stress and its associated factors, a random effects model was used. The funnel plot and Egger's regression test were used to assess publication bias, and I 2 test statistics were used to determine heterogeneity. The protocol for this review has been registered with PROSPERO (ID: CRD42024578490).Results: A total of 23 studies with 8,946 study participants met the inclusion criteria. The pooled prevalence of stress was 37.64% (95% CI: 29.61-45.66; I 2 = 98.8%). Female gender (OR = 1.82, 95% CI: 1.57-2.12), rural resident (OR = 1.51, 95% CI:1.22-1.87), living outside university dormitory (OR = 2.02, 95% CI: 1.34-3.05), alcohol consumption (OR = 1.46, 95% CI: 1.12-1.91), being a cigarette smoker (OR = 2.36, 95% CI: 1.49-3.74), being a khat chewer (OR = 1.35, 95% CI: 1.02-1.80), working in an unfavorable environment (OR = 1.80, 95% CI: 1.20-2.71), and having poor social support (OR = 1.93, 95% CI: 1.39-2.68), were significantly associated with an increased risk of stress.The findings of this study indicated high prevalence of stress. The study identified female gender, being rural residence, living outside university dormitory, khat chewing, and having the habit of alcohol consumption, working in an unfavorable environment, poor social support and cigarette smoking as risk factors for stress. To develop coping skills and resilience, integrating mental health education into the curriculum could help students to prevent stress. Furthermore, strategies such as academic support programs, counseling services, and stress management workshops could be beneficial.