Dating Stress, Depression and Anxiety Symptoms: A Study among University Students in Uganda

Talbert Muhwezi^1*, Maud Kamatenesi-Mugisha² and Herbert E Ainamani^1
*Correspondence: Talbert Muhwezi, Department of Public Health and Psychology, Bishop Stuart University, Mbarara, Uganda, Tel: +256771658025, Email:

Keywords

Stress • Depression • Anxiety • Dating • Students • Uganda

Abbreviations

ACHA-NCHA: American College Health Association-National College Health Assessment; ASSIST: Alcohol, Smoking, and Substance Involvement Screening Test; BSU: Bishop Stuart University; CDC: Centre for Disease Control; CI: Confidence Interval; DRS: Dating Related Stress; DSM-IV: Diagnostic and Statistical Manual of Mental Disorders; GAD: Generalized Anxiety Disorder; NGO: Non- Governmental Organization; OR: Odds Ratio; PHQ-9: Patient Health Questionnaire; UBOS: Uganda Bureau of Statistics; WHO: World Health Organization.

Introduction

Dating related stress is a widespread public health problem that is linked to numerous negative physical and psychological health outcomes. Even though the experiences of dating-related stress among tertiary students tend to be under-reported in low- and middle-income countries (LAMIC), its detrimental consequences remain very high [1]. Previous studies on dating related-stress in LAMIC have attributed this lack of reporting by victims to the socio-cultural context of what people deem as acceptable or unacceptable in society [2]. Moreover, there are unbalanced power relations between victims and perpetrators [3].

Prior studies have found dating related stress to include but not limited to humiliating the partner, controlling what the partner can and cannot do, concealment of information from the partner, deliberately doing something to make the partner feel embarrassed, isolating the partner from friends and family or even denying the victim access to money or other basic resources [4-6]. A study by Edwards et al. [7] observed that these forms of dating stress were more prevalent among adolescents and young compared to the rest of the age groups. It’s not surprising therefore that the recent studies on dating victimization and perpetration have shown that youth dating related stress is prevalent in the United States, with rates ranging from 10-65% [8,9]. In a study conducted among college students on intimate partner violence (IPV), found that 20% of the students involved in a relationship reported dating related stress victimization within their current relationship [10]. Moreover, previous research has estimated that psychological aggression occurs in up to 80% of college student dating relationships, physical aggression in 20-37%, and sexual aggression in 15-25% [11]. Consequently, evidencebased research has continued to indicate a strong correlation between dating related stress and mental health aspects of depression, anxiety, suicide, post-traumatic stress disorder, issues of self-esteem and poor social relationships [12,13]. The recent study on psychological abuse, mental health, and acceptance of dating violence among adolescents found a strong relationship between dating related stress and mental health aspects of depression and Anxiety [14]. In this study, the authors recommended that further studies should be conducted in this area. A few studies that have closely looked at dating related stress in Africa and Uganda in particular only looked at the occurrence of different forms of dating-related stress but did not closely examine its association with aspects of mental health disorders [4,15]. Owing to the paucity of research in the area of dating-related stress and its mental health impact on tertiary students, our study sought to profile the aspects of dating-related stress and its impact on mental health disorders. We hypothesized that 1) Dating related stress would be high among tertiary school students. 2) Dating related stress would be positively correlated with the mental health aspects of depression and anxiety.

Research Methodology

This study utilized a cross-sectional descriptive and analytical design among University students in Mbarara District, Uganda. Mbarara is located approximately 260 kilometers from Kampala capital city in southwestern Uganda. Quantitative (semi-structured in-depth interviews) data collection methods were used to allow the researcher to generate empirical evidence. Quantitative data obtained were tabulated into simple frequency tables and percentages. The data collected from interviews were used to provide explanations of findings from the quantitative analysis to generate information on victims' coping strategies.

In this study, students from Bishop Stuart University were selected, Bishop Stuart is one of the few private universities chartered by the government of Uganda with programs ranging from Bachelors of laws, business, nursing, Psychology, Agriculture, secretarial studies and public health including postgraduate programs with a population of 5,000 students. In this study, we recruited students from undergraduate programs who consented to participate in the study. The convenience sampling design was used to select participants.

Ethical clearance: Ethical approval was obtained from the Bishop Stuart University Research Ethics Committee. All participants provided written consent for participation in the study after an explanation about its objectives, confidentiality, and ethical consideration, and assurance concerning the voluntary nature of participation.

Measures

In this study participants, demographic information that was gathered included age, gender, marital status, religion and area of residence.

Depression

Depression was assessed using PHQ-9. The PHQ-9 consists of nine questions based on the DSM-IV criteria for a major depressive episode. Each of the questions asks participants to select the frequency of the depressive symptoms that they experienced during the past 2 weeks. Scores for each of the 9 items range from 0=not at all to 3=nearly every day. This tool was tested among college students in China and was found to be having an internal consistency and test-retest reliability of 0.854 and 0.873 respectively [16]. Nakku et al. found out that the PHQ-9 was noted to have good psychometric properties (sensitivity=0.74).

Anxiety

Anxiety was assessed using the Generalized Anxiety Disorder (GAD-7). GAD-7 consists of 7-items measuring current (within the past 2 weeks) symptoms of anxiety. Each question of the 7 items is answered using a 0–3 scale, where 0=did not apply to me at all, and 3=applied to me nearly every day. The range of possible scores for the scale is 0-21, with 0 points indicating no anxiety and 21 points indicating severe anxiety. The reliability and validity of this instrument were tested among a population of students and it had an excellent internal consistency at Cronbach α of 0.92 and testretest reliability of 0.83 [17].

Data management and analysis

The collected data was cleaned and coded. It was then entered into Epidata version 3.1 to ease management and after it was exported to STATA version 12 for data analysis. Bivariate statistical analysis was used to explore the frequency distributions of respondents' demographic characteristics concerning dating related stress and the multivariate level of analyses.

Multivariate analysis was carried out to assess the odds of having different mental health aspects about dating related stress. Logistic regression analysis was used to control for possible confounding effects of independent variables on each other to find the independent associations.

Results

Socio-demographic characteristics

60 (42.6%) male respondents in the age group 18 to 24 years had experienced dating related stress, and 81 (57.4%) female respondents in the age category 18-24 years had experienced dating related stress. The results also reveal that 30 (44.8%) male respondents who were single had experienced dating related stress, with 37 (55.2%) female respondents who were single experiencing dating related stress. Furthermore, 68 (50.8%) male respondents reported that they were Protestants who experienced dating related stress. Besides, 64 (47.4%) male respondents who were staying in hostels experienced dating related stress and 71 (52.6%) female respondents who were staying in hostels reported experiencing dating related stress (Table 1).

Prevalence

From Table 2, 56 (21.96%) of the respondents had been insulted or made to feel bad about themselves; the table further shows that 14 (5.49%) of the respondents had been belittled or humiliated in front of other people. A total of 25 (9.8%) of the respondents also indicated that they were intimidated or scared on purpose. Of all the respondents, 40 (15.69%) acknowledged that they were threatened to be hurt or someone they cared about.

It is evident from Table 2, 11 (4.31%) of the respondents had been slapped or thrown with something that could have hurt them at least once or twice. 12 (4.71%) respondents reported that they were pushed or shoved and 3 (1.18%) respondents reported that they had been hit with a fist or some object. 6 (2.35%) reported being kicked, dragged or beaten up and only 3 (1.18%) of the respondents had been threatened with a gun, knife or any other weapon. Only 1 (0.39%) respondent reported being choked or burned on purpose.

Still from Table 2, 71 (27.84%) of the respondents had been forced to have sexual intercourse against their will. 61 (23.92%) of the respondents were forced to have sexual intercourse and they were afraid of what their intimate partner might do. 82 (32.16%) respondents who had been forced to have sexual intercourse found this degrading or humiliating (Table 2). To obtain the overall prevalence, the frequencies of never, once or twice, a few (3-5) times and many (more than 5 times), for respondents who had ever and never experienced any form of dating-related stress in the past twelve months were obtained. 31 (12%) had never experienced dating stress, 24 (9%) experienced dating stress once or twice, 55 (22%) experienced dating stress a few times and 145 (57%) experienced dating stress more than 5 times.

The overall prevalence rate of dating-related stress was 88% (reported at least one episode of stress related to dating).

Association between dating related stress and mental health aspects

Results in Table 3 revealed that students who had ever experienced dating related stress were more than five times more likely to suffer depression compared to those who have never experienced dating related stress (OR=5.1; 95%CI 1.9 13.3; P=0.001). The study findings further revealed that students who had ever experienced dating related stress were more than four times more likely to suffer anxiety than those who have never experienced dating related stress (OR=4.2; 95%CI 1.6 11.1; P=0.004). Students who were married were more than four times more likely to suffer depression compared to those who were single (OR= 4.4; 95%CI 0.6 35.4; P =0.161). The study findings further revealed that students who were residing at home were 0.9 and 0.7 times more likely to suffer depression and anxiety respectively than those who were residing in hostels (OR=0.9; 95%CI 0.3 2.6; P=0.774 and OR=0.7; 95%CI 0.2 1.9; P=0.463).

Discussion

Prevalence

This study found out that the prevalence of dating-related stress among students in tertiary institutions was 88%. This could be due to acculturalization and globalization which have led to the loss of moral fiber in the society, and the affective nature of students to respond to stressors and hormonal changes. Similarly, the current prevalence of dating-related stress was in line with what was reported by Claudia et al. [18] who found a prevalence of 71% among students in Ethiopia. Also, a study conducted in Saudi Arabia among medical students by Sani et al. [19] found out that the prevalence of dating-related stress among students at Jizan University was 71.9%.

Furthermore, the findings from this study agree with those of a study conducted in the USA (57%) by Wiersma-Mosley and Jozkowski [20], who found out that 57% of the students within their sample experienced dating related stress. Also, a study conducted in Australia by Stallman and Shochet [21], found that the prevalence of dating-related stress among students was 53%. The high number of students who had experienced psychological abuse in the current study matched the findings of a study conducted in Russia among university students which revealed that 61.6% of the students taking part in the study reported being survivors of psychological abuse perpetrated by an intimate partner Lysova and Douglas [22].

However, the findings from this study are higher than those of a study conducted among students in Canada which showed that 30% of the students had experienced dating related stress [23]. Furthermore, 41.9% of students in Malaysia had experienced dating related stress, and 10.8% of students in Kenya and 21.6% of students in Ethiopia experienced dating related stress [24,25]. Another study conducted in Ethiopia revealed that 32.6% of the students experienced dating related stress [26].

Also, the prevalence of dating-related stress in the current study was higher when compared with studies in France (25.7%), Norway (22.9%), and Iceland (22.5%) [27-29]. The lower prevalence rate in these studies could be due to a variety of reasons, which include the settings, in which this study was conducted.

This study found out that students who had ever experienced dating related stress were more than five times likely to suffer depression compared to those who have never experienced dating related stress, and the findings further revealed that students who had ever experienced dating related stress were more than four times more likely to suffer anxiety than those who have never experienced dating related stress. This is because the stressful situation may break the social ties which might result in a relationship difficult leading to frustration and hopelessness. The findings of this study are in line with another research study that found that dating related stress perpetration may be related to adverse mental health conditions, such as anxiety and depression, as well as poor anger management [30]. Furthermore, in a study by Hamby & Turner, anxiety found that dating related stress emerges as a significant predictor of social anxiety, fear of negative evaluation.

Besides, a study on dating related stress found that depression is reported as the most common mental health effect among survivors of dating-related stress [12]. Similarly, the current study concurs with that conducted among students in the UK which found that those who experienced dating related stress were 3.3 times more likely to report symptoms of depression and anxiety [31]. More so, a study conducted in Finland found that students who reported dating related stress were associated with a 2.8-fold increased risk of experiencing symptoms of social withdraw, anxiety and depression [32]. This was enhanced by report from a health worker who said that “ some students sort of withdraw, become isolated and don't want to have anything to do with the rest of the world and feel so hurt that they can't even imagine having a positive human relationship again, even with friends and family' (Social worker).

Furthermore, the current findings are in agreement with those of a study conducted among students in the USA which found out that those who experienced dating related stress were more likely to experience emotional distress than those who did not [33]. Additionally, a study conducted by Banyard Charlotte Cross [34], found that students who experienced dating related stress were likely to have higher levels of depression and anxiety compared to those who did not experience dating stress.

Also, the findings from this study concur with a study conducted in Uganda which found that dating related stress reduces a person’s quality of life and self-confidence by exposing her/him to emotional distress [3]. Furthermore, Selic et al. [35] found that students who experienced dating related stress were more likely to report depression, anxiety, and fear. The results of the current study were consistent with those of other studies which found that dating related stress was associated with symptoms of depression and anxiety [36].

Conclusion

In conclusion, this study contributed to existing research on dating stress and mental health aspects in several ways. First, the study identified the prevalence of dating-related stress among students in tertiary institutions (88%). Victims who experienced greater relationship distress were likely to be depressed and anxious. We hope that these results will help provide some insight into what was already known about how victims of datingrelated stress in tertiary institutions cope up with the stress.

Authors’ Contributions

TM participated in the conception and design of the study, collected the data, performed the data analyses, interpreted the data, and drafted the manuscript. HEA participated in the conception and design of the study, supervised data collection, helped in the analysis and revision of the manuscript; MK Participated in the design of the study, all authors read and approved the final manuscript.

Ethical clearance: This study was cleared by Bishop Stuart University Research Ethics committee (BSU-REC).

Acknowledgments

We thank the students who participated in this study; the administrators of Bishop Stuart University for allowing us to interact with their students.

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