DOI: 10.1111/nuf.

12316

ORIGINAL ARTICLE

Depression, anxiety, and stress among college students

in Jordan and their need for mental health services

Heyam F. Dalky PhD, RN | Assel Gharaibeh MSN, RN

Faculty of Nursing, Jordan University of

Science & Technology, Irbid, Jordan Abstract
Introduction: Psychological distress (in the form of depression, anxiety, and stress)
Correspondence
Heyam F. Dalky, PhD, RN, Faculty of Nursing, among college students is prevalent and increasing. In most instances, college
Jordan University of Science & Technology, students with mental health issues are not seeking treatment. Although not a new
PO Box 3030, Irbid 22110, Jordan.
Email: [email protected] phenomenon, little progress has been made toward promoting students’ use of
mental health services in Jordan.
Funding information
Jordan University of Science and Technology, Aim: To measure depression, anxiety, and stress among college students in Jordan
Grant/Award Numbers: 20170011, JD and explore their awareness of available mental health services.
101400
Methods: A convenience sample (n = 600) was tested using the Depression, Anxiety,
and Stress Scale. Students answered questions concerning the use of campus mental
health services.
Results: Findings showed college students have a moderate level of depression,
severe level of anxiety, and a moderate level of stress. Half were not aware that
psychological support services were available, although 54.4% indicated they
experienced problems.
Conclusion: Similar results have been reported in non‐Arab countries. Anxiety
appears to be high in college students worldwide. Strategies are needed to promote
awareness of resources and encourage access. Nurses are ideally suited for
promoting awareness among students on seeking help. They are also needed to
screen students for mental health problems and provide counseling as needed.

KEYWORDS
anxiety, college students, depression, mental health, psychological distress, stress

1 | INTRODUCTION Findings of a cross‐sectional correlation study between stress,

anxiety, and depression and sociodemographic variables among
Mental health is considered as a vital part of well‐being, whereas university undergraduate students in India indicated that half of
poor mental health is associated with decreased productivity, a lesser the sample respondents were affected by depression, 66.9% by
quality of life, and disability.1 Psychological distress, in the form of anxiety, and 53% by stress. Female students consistently scored
depression and anxiety, is associated with serious health conditions.2 higher than males. In addition, fifth‐semester students had more
College students worldwide experience a wide range of stressors, morbidity than students of the second semester.5
and the mental health of this group is considered a global public Low treatment rates for mental disorders have long been
health issue due to the high prevalence of mental health problems.3 reported in the literature, despite the prevalence of mental health
In a systematic review of the literature, Storrie, Ahern, and Tuckett4 and psychological issues. In a study by Hunt and Eisenberg6 over one‐
reported the prevalence and increased incidence of serious mental third of American college students reported being depressed to the
illness in college students worldwide. point of finding it difficult to function, and 1 in 10 reported that they
Nurs Forum. 2019;54:205-212. wileyonlinelibrary.com/journal/nuf © 2018 Wiley Periodicals, Inc. | 205
206 | DALKY AND GHARAIBEH

considered suicide in the previous year. Also in the United States, 3. Is there a relationship between psychological distress—expressed
7
Blanco et al found low treatment rates for mental health issues, with as depression, anxiety, and stress—and students’ demographical
fewer than 20% of students with anxiety receiving treatment. Garlow variables?
et al8 in a study at Emory University reported that only 15% of the
students with moderately severe or severe depression or with 1.2 | Ethical consideration
suicidal ideation received treatment.
Approval to conduct the research was obtained from the Institutional
Psychological distress is of growing concern. Students may be
Review Board (IRB) at the authors’ university system. As well, letters
faced with potential stressors such as financial hardship, academic
of approvals from the administration of the other participating
overload, competition against peers, continual pressure to succeed,
universities assured before contacting students for data collection.
and worries about the future. These stressors can have major effects
Students participation was voluntary, and participation did not affect
on the student academic performance, ability to progress and
their grades. Questionnaires were coded to provide confidentiality
decision to stay at the university. Also, students may have an
and anonymity.
increased risk of depression, anxiety, substance use, and personality
disorders, and other negative consequences later in life.
The awareness about remarkable growing mental health problems 2 | METHODOLOGY
and linked‐negative consequences increase the demand for consider-
ing counseling services offered by professionally qualified and trained A measurement was taken at one point in time of a sample consisting
personnel for university students.6 Counseling psychologists help of junior and senior level students studying at three public Jordanian
students to adjust to change or make changes in their lifestyle. They universities. Students beginning their studies or had not completed
assist students in areas related to personal well‐being, interpersonal 6 months of the study were excluded to minimize bias due to a life
relationships, work, recreation, health, and crisis management.9 change. The majority of students entering university are between
Unfortunately, most of the students who have psychological distress 18 and 21 years old, and, at this stage, dramatic changes in life are
do not receive any therapeutic or counseling services.9 Indeed, the occurring.12
students’ mental health problems are getting more serious and A sample size calculation (G‐power 3 at α = 0.05, moderate effect
complicated, and there is a need for counseling services. size of 0.25, and power = 0.80)13 yielded 155 students per university.
Few studies are located in Jordan. A study among military college To achieve this sample size, an additional 25% was added, resulting in
students in Jordan showed that the academic and social dimensions total n = 610. Of the 610 questionnaires distributed, 10 were
have ranked first and the second source of distress, where the incomplete, defined as one section or less than 50% of the questions
emotional and health dimensions have ranked the third and fourth answered. A final number of 600 completed questionnaires were
source; moreover, the family dimension has ranked the last source of included in data entry and analysis.
distress.10
One of the worst crises in Jordan that may have a great impact on
2.1 | Study instruments
college students is the Syrian refugees crisis. Carrion11 reported that
the rise in the refugees has affected public services for all, Participants completed a demographic questionnaire and the short
particularly in the northern governorates. The quality and availability version of the Depression, Anxiety, and Stress Scale (DASS 21, Arabic
of education and healthcare have declined as overstrained facilities version) in the presence of the investigator. The second part of the
have great efforts to cope with the significant increase in numbers of demographic form consisted of nine items developed by the National
students and patients. Thus, the Northern provinces confront Alliance of Mental Illness (NAMI) as an initiative to develop
challenges that may have impacts on academic, social, and health interventional programs to fight stigma among college students in
dimensions of college students and overall population, which could the United States. The author got approval to use the items and
lead to psychological distress. translate them into the Arabic language.
On the DASS, the Depression subscale consists of seven symptom
dimensions, namely dysphoria, hopelessness, devaluation of life, self‐
1.1 | Study purpose
deprecation, lack of interest/involvement, anhedonia, and inertia. The
The purpose of this study was to measure psychological distress (in Anxiety subscale includes the four symptom dimensions namely
the form of depression, anxiety, and stress) among Jordanian college autonomic arousal, skeletal musculature effects, situational anxiety,
students and to explore students’ awareness and access of existing and subjective experience of anxious affect. The Stress subscale
resources. To this end, the research questions were as follows: includes the five main dimensions difficulty relaxing, nervous arousal,
easily upset/agitated, irritable/overreactive, and impatient.
1. What is the level of depression, anxiety, and stress among a The 21 items on the DASS were rated on a 4‐four‐point scale,
sample of Jordanian university students? where 0 corresponded to “did not apply to me at all” and 3 to “applies
2. To what extents are students aware of and make use of to me very much.” The students were asked to indicate to what extent
university‐provided sociopsychological services? they had experienced each item during the past week. Item scores
DALKY AND GHARAIBEH | 207

were added together for each dimension and multiplied by two (as for the DASS 21 subscales. T tests were used to examine the
14
per DASS manual) to equal 42, the number of the long form DASS. differences in the mean scores among sociodemographic variables and
Results were shown as mild (lowest scores), moderate, severe, or depression, anxiety, and stress, where a P value at 0.05 was considered
extremely severe (highest scores) for the subscales of depression, significant. The data were analyzed using SPSS version 21.0.17
anxiety, and stress.
According to the DASS manual, emotional syndromes like
depression and anxiety are intrinsically dimensional—they vary along 3 | RESULTS
a continuum of severity.14 Hence the selection of a single cutoff score
to represent “clinical” severity is necessarily arbitrary. This is one of As shown in Table 1, students were predominately between 17 and
the fundamental differences between the DASS and categorical 21 years of age, and more females (64%, n = 388) than males (35.3%,
measures based on psychiatric diagnosis.14 n = 212) participated. Also, the majority were single (95.7%, n = 574)
Further, DASS authors developed a set of cut‐off scores for and few were used (8%, n = 47). Grade point averages (GPA) were for
defining mild/moderate/severe/extremely severe scores for each the most part good or above, and most students carried between
DASS scale; as guided by the DASS manual.14 Psychometrically, the 9 and 18 hours, with the largest percentage (47.3%, n = 284) carrying
DASS is quite different from diagnostic instruments in that it reflects between 9 and 12 hours. More than half of the students (57.7%,
the underlying continuity of severity of symptoms in the population14; n = 346) were at senior level.
DASS scale scores are dimensional rather than categorical.

3.1 | Psychological and social support services

2.1.1 | Psychometric properties of the instruments
This section reports on the data for the total sample enquired by the
Lovibond and Lovibond14 established the reliability of the DASS three universities from which selected students taking part in this
through a comparison with Beck Depression and Anxiety Inventories. study. Reports on each of the three universities surveyed revealed no
The scale is widely used in published literature to measure differences amongst the three universities. However, data available
depression, anxiety, and stress and reported evidence of reliability from the author upon request.
and validity.5,15,16 As shown in Table 2, a majority (60.2%, n = 360) did not know
Both, the DASS and the NAMI‐9 items; translated and back how to seek social support in the university. Moreover, half of the
translated into Arabic language. Professional bilingual and bicultural students (51.2%, n = 303) did not know there was such a center. Of
nursing experts reviewed the Arabic copies of the study instruments the students who did visit the center (n = 259), 24.3% (n = 146) found
and tested for reliability and content validity. The pilot testing the services to be very helpful or helpful. When asked if they had
revealed scales with acceptable reliability (r = 0.90) and validity experienced psychological problems during their time at the
evidence to support use in the study context. university, 45.6% (n = 267) responded that they had. As to which
service (from a list, item 6) did they consider the most important, the
item with the highest frequency was for “I do not know/none of
2.2 | Data collection procedure
the above” (22.5%, n = 135). Although there was no outstanding
In this study, the researcher met the students during their study time frequency of response to the choices listed (item 9) for the question
at each university. Upon their acceptance to participate, they were of which service did the student prefer, high responses were given
given the study questionnaires to complete in their own and free for “Invitation of a psychological consultant upon need” (18.5%,
time. Arrangements were made to bring back the completed n = 168) and “Webpage or website to have online consultations with
questionnaires. The three public universities included in this study a psychological consultant” (17.6%, n = 160).
have a similar start date for the academic year semesters. Although
variations for examination dates might exist, the authors tried the
3.2 | Depression, anxiety, and stress measures
best to collect the study data during the beginning of the semester to
avoid examination times and stress inquired during these “hectic” and As shown in Table 3, mean scores for depression were designated
stressful periods of students academic lives. moderate (18, range = 14‐20), anxiety as severe (16.9, range = 15‐19),
and stress as moderate (19.15, range = 19‐25). Over half of the
students (58.2%, n = 349) rated their anxiety as severe or extremely
2.3 | Statistical analysis
severe.
The study design was a descriptive, cross‐sectional study, and As shown in Table 4, the relationship between the DASS scores
variables were either categorical or continuous. Descriptive statistics and student demographics showed significant differences only for
were used to describe sample demographic characteristics. Normality sex on the dimension of anxiety. In this case, males (M = 18.02,
of the continuous variables was examined by using Pearson’s measure SD = 9.5) had a significantly (P = 0.026) higher level of anxiety than
of skewness values and standard error of skewness. Levels of females (M = 16.24, SD = 9.45, n = 388). Further, male students had
depression, anxiety, and stress were determined by the mean scores higher mean scores of depression and stress, respectively, than
208 | DALKY AND GHARAIBEH

T A B L E 1 Sociodemographic profile of student participants (N = 600)

University 1 (N = 189) University 2 (N = 203) University 3 (N = 208) Total (N = 600)
Variables number (%) number (%) number (%) number (%)
Age, y
17‐19 146 (77.2%) 28 (13.8%) 76 (36.5%) 250 (41.7%)
20‐21 32 (16.9%) 101 (49.8%) 83 (39.9%) 216 (36%)
≥22 11 (5.8%) 74 (36.5%) 49 (23.6%) 134 (22.3%)
Sex
Male 58 110 44 212 (35.3%)
Female 131 93 164 388 (64.7%)
Civil status
Married 8 (4.2%) 8 (3.9%) 6 (2.9%) 22 (3.7%)
Single 177 (93.7%) 195 (96.1%) 202 (97.1%) 574 (95.7%)
Divorced/widowed 4 (2.1%) 0 (0%) 0 4 (0.6%)
Occupation status
Used 11 (5.9%) 14 (6.9%) 22 (10.6%) 47 (8%)
Not used 177 (94.9%) 189 (93.1%) 186 (89.4%) 552 (92%)
GPA
Fair 97 (51.9%) 30 (14.8%) 26 (12.5%) 153 (25.5%)
Good 24 (12.8%) 88 (43.3%) 63 (30.3%) 175 (29.2%)
Very good 24 (12.8%) 48 (23.6%) 81 (38.9%) 153 (25.5%)
Excellent 22 (11.8%) 23 (11.3%) 11 (5.3%) 56 (9.3%)
Honor degree 20 (10.7%) 14 (6.9%) 27 (13%) 61 (10.7%)
Academic hours
9‐12 170 (90.4%) 41 (20.2%) 73 (35.1%) 284 (47.3%)
13‐18 15 (8%) 130 (64%) 112 (53.8%) 257 (42.8%)
>18 3 (1.6%) 32 (15.8%) 23 (11.1%) 58 (9.7%)
Academic year
Junior students 254 (42.3)
Senior students 346 (57.7)
Abbreviation: GPA, grade point averages.

female students; however, these relationships were not statistically depression and stress. The authors noted that the main stressors for
significant, see Table 4. students were academic and personal factors.
Likewise, Shamsuddin et al20 found higher scores for anxiety than
for depression or stress among a sample of 506 students in Malaysia.
4 | D IS C U S S IO N The authors noted that 27.5% (n = 139) had moderate and 9.7%
(n = 49) had severe or extremely severe depression, 34% (n = 172) had
The aim of this study was to measure depression, anxiety, and stress moderate and 29% (n = 146) had severe or extremely severe anxiety;
among Jordanian college junior and senior level students and to explore and 18.6% (n = 94) had moderate and 5.1% (n = 25) had severe or
their knowledge and awareness of psychological help and guidance extremely severe stress scores. Although not found in the current
services provided by their university. Albeit a convenience sample, the study, the authors noted a correlation with age in that both depression
study participants were representative of the Jordanian undergraduate and anxiety scores were significantly higher among older students
students in terms of age, GPA, and the number of hours carried but (20 and above), and stress scores were significantly higher among older

unequal as to gender. Across the three universities, students were students (20 and above). One reason for this; as students increase in
enrolled in 28 colleges, demonstrating a wide diversity of subject majors. age, they become more mature and realize the responsibilities and

Literature reports findings of several studies using the DASS to challenges they are facing and having to manage.12
measure depression, anxiety, and stress in university students.
One study results found that undergraduate Malaysian students
4.1 | Awareness of psychological services
expressed having moderate to extremely severe levels of psycholo-
gical distress.18 Our finding that students scored higher in anxiety Few studies have been conducted in Jordan regarding student
than in depression or stress is supported by Al‐Ani et al19 who found psychological distress. A study conducted in a Jordanian university
that about half of the sample of Malaysian students responding to showed that academic and social dimensions ranked as primary sources
the DASS short form reported high for anxiety and low for both of distress, whereas emotional and health dimensions ranked lower.10
T A B L E 2 Student responses to awareness and use of psychological and social services (N = 600)
DALKY

Item 1 Yes (%) No (%)

AND

Do you know how to seek psychological and 238 (39.8%) 360 (60.2%)
social support in your university?
Item 2 Did not attend (%) Very helpful (%) Helpful (%) Somewhat Not so much Not helpful at all (%)
helpful (%) helpful (%)
GHARAIBEH

If you were in the Psychological and Social 341 (56.8%) 48 (8%) 98 (16.3%) 63 (10.5%) 29 (4.8%) 21 (3.5%)
Support Center, how helpful were they?
Item 3 I do not Orientation (%) Website (%) College (%) Health center (%) University ads (%) Others (%)
know (%)
How did you know about psychological and 194 (30.3%) 126 (19.7%) 81 (12.7%) 35 (5.5%) 132 (20.6%) 31 (4.8%) 41 (6.41%)
social support services in your university?
Item 4 Yes (%) No (%)
Are there psychological and social support 289 (48.8%) 303 (51.2%)
services in your university?
Item 6 Which psychological and social support service do you see most important for you in your
academic life?
Walking in the Center 48 (8%)
Psychological screening and evaluation 125 (20.8%)
Individualized consultation with a set number of sessions 82 (13.7%)
Continuous consultation 106 (17.7%)
Peer support 24 (4%)
Medication prescription 25 (4.2%)
Pharmaceutical treatment 17 (2.8%)
Seeking external specialized center help 21 (3.5%)
Transportation services to specialized centers 17 (2.8%)
I do not know/none of the above 135 (22.5%)
Item 7 Yes (%) No (%)
Did you experience any psychological problems during your 267 (45.6%) 318 (54.4%)
academic life in university?
Item 8 Excellent Good Fair Weak I did not share having a problem
How do you see your university response to that problem? 74 (12.4%) 126 (21%) 86 (14.4%) 61 (10.2%) 252 (42%)
Item 9 Which of these psychological and social support services do you prefer to apply in your university?
Psychological Crisis Response Team 152 (16.5%)
Having psychological services inside the campus 104 (11.4%)
Treatment in hospital 93 (10.2%)
Invitation of a psychological consultant upon need 168 (18.5%)
Monitoring, diagnosis, and treatment from a specialized team 112 (12.3%)
Specialized psychological service center inside the campus 120 (13.2%)
|

Webpage or website to have online consultations with a psychological consultant 160 (17.6%)
209
210 | DALKY AND GHARAIBEH

T A B L E 3 Depression, Anxiety, and Stress Scale (DASS) scores of students (n = 600)

Scales Mean (± SD) Normal N (%) Mild N (%) Moderate N (%) Severe N (%) Extremely severe N (%)
Depression 18 (± 9.7) 92 (15.3) 60 (10.0) 188 (31.3) 139 (23.2) 121 (20.2)
Anxiety 16.9 (± 9.34) 111 (18.5) 29 (4.8) 110 (18.3) 88 (14.7) 261 (43.5)
Stress 19.15 (± 9.51) 227 (37.8) 74 (12.3) 142 (23.7) 117 (19.5) 35 (5.8)
Score ranges: Depression—normal, 0 to 9; mild, 10 to 13; moderate, 14 to 20; severe, 21 to 27; extremely severe, 28+. Anxiety—normal, 0 to 7; mild, 8 to 9;
moderate, 10 to 14; severe, 15 to 19; extremely severe, 20+. Stress—normal, 0 to 14; mild, 15 to 18; moderate, 19 to 25; severe, 26 to 33; extremely severe, 34+.

T A B L E 4 Difference between male and female students for

Depression, Anxiety, and Stress Scale (DASS) scores campus.4 An earlier study in an American University that studied
mental health in students at baseline and in a 2 year follow‐up found
Independent t test Subfactors Mean (SD) t Significance
that half of the students with one or more mental health issues failed
Stress Male 18.85 (9.38) 1.49 0.136
Female 17.62 (9.89)
to seek treatment.9
Downs and Eisenberg23 reported that the most commonly
Anxiety Male 18.02 (9.05) 2.24 0.026*
Female 16.24 (9.45) reported barriers to seeking treatment were: (1) a preference for
dealing with stress alone (73.3%); (2) the belief that stress is normal
Depression Male 20.07 (8.77) 1.76 0.080
Female 18.65 (9.87) in university (52.2%); (3) not seeing their needs as serious (52.1%);
*
Significant at α = 0.05 (two‐tailed). and (4) not having time for treatment (46.7%). It is important to note
that in Arab countries, there is a stigma attached to seeking help for
Although, in the current study, 45.6% of the students reported having mental problems.24 This is a cultural aspect that may be a barrier to
one or more psychological problems, they seemingly lacked awareness students experiencing episodes of depression, anxiety, and stress.
of resources for mental health issues and psychological services. Also, due to the Syrian refugee crises, public services and community
Furthermore, 60.2% did not know how or where to seek support. This resources have been greatly strained as these services strive to cope
was in spite of information in student orientation packets and posted with the increased number of patients.11
flyers advertising the services and accompanying websites.
In part 2 of the Demographic Questionnaire (item 9), students
4.3 | Study implications
provided information regarding what they considered to be the most
important psychological and social services that the university should The results from this study will aid university leaders to develop
provide. Given a list of nine items, the top three responses were as innovative programs and nonthreatening interventions to decrease
follows: the invitation of psychological consultant upon need (18.5%), psychological distress and promote access to mental health services.
webpage or website to have online consultations with a psychological Because the stigma attached to admitting a need for aid is world‐
consultant (17.6%), and psychological crisis response team (16.5%). Of wide and not just a problem for Jordanian and Arab‐world students,
note is that these choices not only suggest that the student wanted to the approach must promote awareness that seeking help is an
be in control, but that also mental health nurses could fulfill these roles. acceptable alternative and renders benefits. Nurses in mental health
In 2008, the National College Health Assessment, a national practices, both within the university campus setting and in family or
survey of student sponsored by the American College Health community settings are ideally suited for helping students to
Association (ACHA‐NCHA), showed that 95% of university directors overcome prejudices and reassuring them that accepting help,
reported a significant increase in psychological problems among their regardless of the strategies used, is a good choice.
students.6 This increase appears to be a growing trend. Osberg21 Researchers have over the past decades developed various
noted that the incidence and seriousness of psychological distress strategies. One such is preventive in that students are given information
among university students were on the rise more than a decade ago. about potential problems and ways to cope.25 Such psychoeducational
The current finding that few students with mental health problems programs, also offer opportunities for group discussion so that students
actively seek help supports a need for consultation and support have the chance to discuss their personal experiences, receive support
services. Negative outcomes may include dropouts, increased suicidal or encouragement from others, and recognize that their personal
tendency, marital and social troubles, ineffective and inefficient work experiences are not unique.25 Psychiatric nurses are qualified to do this.
22
performance, burnout, and healthcare‐related problems. Another approach has been to help students develop coping behaviors.
These programs typically emphasize procedures such as cognitive
restructuring, relaxation, mindfulness, conflict resolution, and effective
4.2 | Nonaccess to and barriers to seeking help
communication.25 These are strategies that mental health nurses can
A major recommendation of a world‐wide systematic review was that develop and promote.
institutions should increase student awareness of counseling and Also, based on student responses in the current study, sugges-
mental health resources both within and without the university tions to improve the current available system may include a
DALKY AND GHARAIBEH | 211

specialized center or team to deal with students that require appreciated. The authors also thank all students for taking the
guidance or consultation. As we are in the era of technological time to fill out the questionnaires and assist the authors in
advancement and computerization, this could be done online through achieving the goals of this study.
a webpage or university website that is attended by assigned
specialist personnel, such as a mental health nurse. Collaborations
among nurses both in technology information systems and mental ORCI D
health have an opportunity to develop web‐based interventions that
Heyam F. Dalky http://orcid.org/0000-0002-5744-4038
permit students to receive guidance 24 hours a day that is easily
accessible. Furthermore, this approach circumvents the stigma of
physically attending a center. R E F E R E N CE S
Results of the current study essentially provide benefits for
nurses in mental health practice. Knowing that anxiety is 1. Kaur J, Masaun M, Bhatia M. Role of physiotherapy in mental health
disorders. Delhi Psychiatry J. 2013;16(2):404‐408.
prevalent, followed by stress and depression, nurses working in
2. Seedat S, Scott KM, Angermeyer MC, et al. Cross‐national associa-
social services, counseling, or providing therapy can promote tions between gender and mental disorders in the World Health
interventions that are nonthreatening yet address students’ Organization World Mental Health Surveys. Arch Gen Psychiatry.
needs. In most countries, nurses are respected and not feared. 2009;66(7):785‐795.
3. Stallman HM. Psychological distress in university students: a
Furthermore, nurses play a vital role in screening and assessing
comparison with general population data. Aust Psychol. 2010;
students’ needs and building trust relationship to guide them to 45(4):249‐257.
overcome challenges and stressors during university life. 4. Storrie K, Ahern K, Tuckett A. A systematic review: students with
mental health problems—a growing problem. Int J Nurs Pract.
2010;16(1):1‐6.
4.4 | Study limitations 5. Iqbal S, Gupta S, Venkatarao E. Stress, anxiety & depression among
medical undergraduate students & their socio‐demographic corre-
Although one of the first to consider the extent of psychological lates. Indian J Med Res. 2015;141(3):354‐357.
distress in Jordanian students, the research is preliminary. Because 6. Hunt J, Eisenberg D. Mental health problems and help‐seeking behavior
sample participants volunteered, it is conceivable that participating in among college students. J Adolesc Health. 2010;46(1):3‐10.
7. Blanco C, Okuda M, Wright C, et al. Mental health of college students
a research study that required personal responses appealed mostly
and their non–college‐attending peers: results from the national
to those who either knew they had issues or were sufficiently aware epidemiologic study on alcohol and related conditions. Arch Gen
that they were not threatened. Psychiatry. 2008;65(12):1429‐1437.
8. Garlow SJ, Rosenberg J, Moore JD, et al. Depression, desperation,
and suicidal ideation in college students: results from the American
Foundation for Suicide Prevention College Screening Project at
5 | CONC LU SION
Emory University. Depress Anxiety. 2008;25(6):482‐488.
9. Zivin K, Eisenberg D, Gollust SE, Golberstein E. Persistence of mental
Psychological distress in the form of depression, anxiety, and stress is health problems and needs in a college student population. J Affect
a real concern. Even if counseling centers and resources exist within Disord. 2009;117(3):180‐185.
the university campus, there is little awareness of them and less 10. Al‐Tarawneh RA, Kahtoon N. Sources of stress among Jordanian
college students: A case study of Mutah university. Indian Journal of
access. System‐wide initiatives are required that includes university
Health and Wellbeing. 2014;5(6):735.
administrators, academic instructors and advisors, school and 11. Carrion D. Syrian refugees in Jordan: confronting difficult truths. 2015.
community nurses, nurses in mental health practice, and student https://www.chathamhouse.org/sites/default/files/publications/
peers. It should be as acceptable to seek mental health aid as it is to research/20150921SyrianRefugeesCarrion.pdf
12. Marttinen E, Salmela‐Aro K. Personal goal orientations and subjective
seek help for physical health. The authors recommended further
well‐being of adolescents. Jpn Psychol Res. 2012;54(3):263‐273.
studies to explore this phenomenon in a more depth manner. Future 13. Faul F, Erdfelder E, Lang AG, Buchner A. G* Power 3: A flexible
studies should include student life‐styles and their correlation with statistical power analysis program for the social, behavioral, and
the manifesting of mental health issues as well as explore barriers to biomedical sciences. Behav Res Method. 2007;39(2):175‐191.
14. Lovibond PF, Lovibond SH. The structure of negative emotional
access.
states: comparison of the Depression Anxiety Stress Scales (DASS)
with the beck depression and anxiety inventories. Behav Res Ther.
1995;33(3):335‐343.
A C K N O W L E D GM E N T S 15. Cheung T, Wong SY, Wong KY, et al. Depression, anxiety and
symptoms of stress among baccalaureate nursing students in Hong
This study was funded by the Deanship of Research at Jordan Kong: a cross‐sectional study. Int J Environ Res Public Health.
University of Science and Technology (grant no. 20170011; JD 2016;13(8):779.
1014, 00). The authors would like to express a great appreciation 16. Madihie A, Said MS. Depression, Anxiety, and Stress Scale (DASS‐21)
among counselling students: a preliminary study. J Cognit Sci Human
to Dr Nahla AlAli for her valuable and constructive suggestions
Develop. 2015;1(1):90‐101.
during the Statistical Analysis of this research work. Her will- 17. SPSS Version 21.0. IBM SPSS Statistics for Windows, 2013. Armonk,
ingness to give her time so generously has been very much NY: IBM Corp.
212 | DALKY AND GHARAIBEH

18. Gan WY, Mohd nasir MT, Zalilah MS, Hazizi AS. Direct and indirect 25. Dacre pool L, Qualter P. Improving emotional intelligence and
effects of sociocultural influences on disordered eating among emotional self‐efficacy through a teaching intervention for university
Malaysian male and female university students. A mediation analysis students. Learn Individual Diff. 2012;22(3):306‐312.
of psychological distress. Appetite. 2011;56(3):778‐783.
19. Al‐Ani ASR, Faisal GG, Ali SM, Ismail M. Source of stressors and
emotional disturbances among undergraduate science students in AUTHOR’S BIOGRAPHIES
Malaysia. Int J Med Res Health Sci. 2014;3(2):401‐441.
20. Shamsuddin K, Fadzil F, Ismail WSW, et al. Correlates of depression, Dalky, Heyam F., PhD, RN, is a Associate Professor at Faculty of
anxiety and stress among Malaysian university students. Asian J Nursing/Jordan University of Science & Technology, Irbid, Jordan.
Psychiatry. 2004;24(5):33‐36.
21. Osberg TM. A business case for increasing college mental health Gharaibeh, Aseel, MSN, RN, is a Graduate Nursing Student at Faculty
services. Behav Health Management. 2004;24(5). 33. 36. of Nursing/Jordan University of Science & Technology, Irbid, Jordan.
22. Teh CK, Ngo CW, Zulkifli RA, Vellasamy R, Suresh K. Depression,
anxiety and stress among undergraduate students: a cross
sectional study. Open J Epidemiol. 2015;5(4):260‐268.
23. Downs MF, Eisenberg D. Help seeking and treatment use among How to cite this article: Dalky HF, Gharaibeh A. Depression,
suicidal college students. J Am Coll Health. 2012;60(2):104‐114. anxiety, and stress among college students in Jordan and their
24. Dalky HF. Perception and coping with stigma of mental need for mental health services. Nurs Forum. 2019;54:
illness: Arab families’ perspectives. Issues Ment Health Nurs.
205‐212. https://doi.org/10.1111/nuf.12316
2012;33(7):486‐491. https://doi.org/10.3109/01612840.2012.
676720