The study, led by Daniel Kamara and Sullay Kalokoh of Njala University’s School of Public Health, recruited 239 students across three academic levels: the Preliminary stage, the Higher National Diploma, and the Bachelor of Science program. Participants completed a structured questionnaire that combined the Perceived Stress Scale, a widely used ten-item instrument known as the PSS-10, with the twelve-item General Health Questionnaire, or GHQ-12, a validated screening tool for probable psychiatric morbidity. The researchers also administered a ten-item checklist of institutional stressors developed for the local context, asking students to rate how much each pressure contributed to their overall stress burden.

The numbers are sobering. The mean PSS-10 score across the sample was 22.8, with a standard deviation of 5.7, and the researchers defined high stress as a score of 27 or above on the scale. Using that threshold, 26.4 percent of students fell into the high-stress category, with a 95 percent confidence interval ranging from 21.2 to 32.3 percent. Meanwhile, 94.6 percent scored at or above 14, the cutoff for moderate-to-high stress, indicating that stress is not a marginal problem affecting a vulnerable minority but a near-universal condition within this student population. Even more alarming, 82.8 percent of participants screened positive for probable psychiatric morbidity on the GHQ-12, using the conventional threshold of a score of four or higher, a finding that suggests the psychological toll extends well beyond everyday academic worry into territory more commonly associated with clinical mental health concerns.

When students were asked which institutional factors contributed most to their stress, the results painted a vivid picture of life at a resource-constrained West African university. Heavy academic workload topped the list, earning a mean stress-contribution score of 4.12 on the study’s rating scale. But the second-ranked stressor was not academic at all: unauthorized monetary demands, meaning informal requests for payments that students should not have to make, scored 4.06, nearly matching the burden of coursework itself. The burden of university fees came third at 3.83. That informal financial extraction from students ranks alongside tuition costs and academic demands as a leading source of psychological distress is one of the study’s most distinctive and troubling findings, pointing to institutional vulnerabilities that go far beyond the usual pressures of university life.

To understand which factors independently predicted the most severe stress, the researchers turned to binary logistic regression, defining high stress as a PSS-10 score of at least 27 and reporting both crude and adjusted odds ratios. The single strongest predictor was heavy social media use. Students who reported spending more than four hours per day on social media had roughly ten times the odds of high stress compared with lighter users, with an adjusted odds ratio of 10.2 and a 95 percent confidence interval spanning 4.66 to 22.32. This is an extraordinarily large effect by epidemiological standards, and it suggests that digital habits are deeply entangled with psychological wellbeing in this population, whether as a cause of distress, a symptom of it, or both.

Academic level mattered as well. Students enrolled in the Higher National Diploma program faced 4.64 times the odds of high stress relative to their peers at other levels, with a confidence interval of 2.13 to 10.08, a finding the authors link to the intensified demands that arrive mid-program. Financial strain emerged as another dominant thread: students who perceived a heavy fee burden had 3.73 times the odds of high stress, and those who were financing their own education rather than relying on family support had 3.38 times the odds. High academic workload independently predicted high stress with an adjusted odds ratio of 3.44, and female students faced 2.24 times the odds compared with male students, a pattern consistent with broader international literature showing that women in higher education frequently carry a disproportionate share of psychological distress.

Taken together, the adjusted analysis reveals that psychosocial stress at Njala University is profoundly multifactorial. No single pressure explains the burden; rather, financial precarity, institutional demands, gender, academic stage, and digital behavior interact to shape each student’s risk. The researchers used chi-square tests to examine categorical associations and Spearman’s rank correlations to explore relationships between continuous variables before building the final regression model, a methodologically careful approach that strengthens confidence in the adjusted estimates. The study received ethical approval from the Research Ethics Committee of the School of Public Health at Njala University, was conducted in accordance with the Declaration of Helsinki, and relied on voluntary, anonymous participation with written informed consent from every participant.

The fact that the study population consists of public health students adds a layer of irony and urgency to the findings. These are young people being trained to identify and mitigate threats to community health, yet nearly all of them are themselves experiencing significant psychological strain, and more than four in five screen positive for probable psychiatric morbidity. A workforce entering Sierra Leone’s health sector while carrying unaddressed stress of this magnitude raises serious questions about burnout, retention, and the long-term resilience of the country’s public health capacity. International evidence has repeatedly shown that untreated distress among health professions students predicts burnout and attrition later in their careers, making early intervention not merely a matter of student welfare but of national health system planning.

The authors argue that universities should respond on several fronts simultaneously. Their recommendations include flexible fee arrangements that ease the financial squeeze on students, institutional safeguards against the unauthorized monetary demands that ranked second among all stressors, and dedicated digital-wellbeing support to help students manage the social media habits so strongly associated with high stress. Each recommendation maps directly onto an independent predictor identified in the regression analysis, giving university administrators a concrete, evidence-based agenda rather than a vague call for improved student services. In a context where mental health resources across Sierra Leone remain scarce, structural and administrative changes may represent the most feasible first line of defense.

Beyond its immediate institutional implications, the study fills a significant gap in the global mental health literature. Most research on student psychosocial stress comes from high-income countries and from well-resourced universities in middle-income settings, leaving the experiences of students at institutions like Njala University largely undocumented. By establishing a quantitative baseline with validated instruments and reporting prevalence figures with precise confidence intervals, the study enables future research to track whether conditions improve or deteriorate over time, and provides comparative data for similar institutions across West Africa. As university enrollment continues to expand across the region, understanding the psychological costs borne by students, and the specific local pressures that drive them, will be essential to building higher education systems that train health professionals without breaking them first.

Subject of Research: Prevalence and determinants of psychosocial stress among public health students at a Sierra Leonean university

Article Title: Prevalence and determinants of psychosocial stress among public health students at Njala University, Sierra Leone

Article References: Prevalence and determinants of psychosocial stress among public health students at Njala University, Sierra Leone. (n.d.). https://doi.org/10.1007/s44192-026-00595-1

Image Credits: AI Generated

DOI: 10.1007/s44192-026-00595-1

Keywords: psychosocial stress, PSS-10, GHQ-12, university students, Njala University, Sierra Leone, mental health, university fees, social media, public health students, academic workload, cross-sectional study