CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Anxiety is a psychological and physiological state characterized by physical, emotional,

cognitive, and behavioural components. Anxiety means trouble; in either presence or abs

ence of psychological stress, anxiety can create a feeling of fear, worry, uneasiness, and d

read. It is considered to be a normal response to stress. It may help an individual to cope

with the demands of life but in excess it may be considered as anxiety disorder reported

that anxiety is a global problem affecting mainly children and adolescents.

In America, anxiety is the most common illness and approximately 40 million adults have

anxiety disorders. Carter (2017) observed that an optimal level of arousal and mindset is

necessary to best complete a task such as an examination, perform an act or compete in

an event. However, when the anxiety or level of arousal exceeds that optimal level, the

result is decline in performance. Hence the individual fails to fulfill the required

obligation.

Anxiety is an intrinsic part of human nature and if we learn why something happen, it

usually becomes less frightening. Psychologists made a distinction between two basic

types of coping strategies which include problem focused strategies and emotion focused

strategy. Problem focused strategy attempts to deal with those aspects of environment

that are responsible for stress and anxiety expression, that is dealing directly with the

stress situation while emotion focused strategy tends to change the way a person thinks

about a stressful situation.

1
It is when anxiety is in its severe form that some students experience genuine problem in

academics. Their minds go blank, they experience the shakes, their hands go numb and

they suffer from a number of sudden disabilities associated with anxiety during

examination. Academic performance is the outcome of education. It refers to the extent to

which a student, teacher or institution has achieved their educational goals. This goal is

known to be influenced by anxiety.

Combs (2018) reported that anxiety can occur as a result of stress, affecting learning and

memory and also affecting academic performance negatively. According to him, an

optimal level of stress can enhance learning ability and improve academic performance.

Many studies have revealed that student’s performance in schools, college and

universities are affected by symptoms of anxiety which may interfere with their academic

achievement and affect their future employment (Eisenberge, Sarah, Golberstein &

Jennifer, 2017).

Bayram and Bilgel (2018) reported high prevalence of anxiety to be 47.1% respectively,

among a group of Turkish nursing students. This is consistence with other studies which

reported high rate of psychological morbidity among nursing students globally. Some

studies have shown some risk factors associated with these psychological problems

among students. Examples are: the junior students had higher reaction to anxiety than the

senior student probably due to the difficulty in adjusting to new environment (Aysan,

2015).

Females are reported to have higher level of anxiety which can be attributable to bio-

psychological factors such as social roles and physiological status (Ahmed, 2019).

2
Wadsworth and Berger (2016) found that children from families facing conflict such as

divorce where associated with anxious behaviours and other psychological distress. Also

university students who originate from rural areas, where reported to score higher in

anxiety scale compared to students with an urban background. This can be explained by

an economic situation where students with rural backgrounds reported poor family

economic situations. It is believed that satisfactions with the living environment act as

protective hand dissatisfaction with living arrangements would lead to a risk on one

wellbeing.

Anxiety disorders are the most common class of psychiatric disorders in the U.S. and

many other countries. In U.S.A. alone, anxiety disorders affected about 40 million adult

aged 18years and older. (About 18% of the total population annually are affected

approximately 28.8% of the U.S. population in a life time).

In Nigeria, anxiety is also one of the most common mental disorders in population aged

18years and older showed that the current prevalence of anxiety disorder was about 5.6%.

It was therefore, estimated that one eight of the total population worldwide suffers from

anxiety disorder (National Institute of Mental Health America, 2014).

Mental illness throughout the world and in Nigeria is a common occurrence.

Neuropsychiatric disorders, including mood and anxiety disorders, account for

approximately 14% of global burden of disease and affect over 450 million people

worldwide (Blair, 2015).

According to World Health Organization (WHO, 2016), there is a wide range in

prevalence of mental disorders. They added that the United States has consistently high

3
prevalence rates across all classes of disorder as compared to other countries (WHO,

2016). Within the mental illness category, internalizing disorders, such as major

depression and phobias, are the most common anxiety-mood disorders in the United

States (Kessler, & Wittchen, 2016).

Anxiety has been shown to interfere with people’s overall wellbeing. Anxiety consists of,

often irrational, fears or worries as well as physical symptoms (Muris & Frick, 2015).

Research surrounding the general topic of anxiety is readily available.

The school setting is not all bad. Teachers, counselors, administrators, and peers are all in

a unique position to bring awareness to anxiety and teach effective ways to cope or

manage anxiety (Thompson 2015). Often, the school setting can be a first line of defense

for students in dealing with mental health concerns.

Unfortunately, more students are experiencing problematic anxiety than are recognized or

treated within the school. Effective coping skills can help students overcome many of the

challenges they face during adolescence and throughout life. The longer problems with

anxiety go unnoticed the more impact they will have on adolescent’s lives (Ingul, 2017).

Awareness and treatment of anxiety can be crucial in reducing comorbidity among

mental health disorders, slowing progression of anxiety into adulthood and offering

adolescents’ protection from the stressors that are frequent during that stage of life.

Students would be able to function more effectively and focus more on academics,

reducing behavioral, attendance, and social concerns for students themselves, teachers,

and administrators. Involving parents could help create consistent support and potentially

encourage them to seek help for their own needs, if they exist (Bogels , 2017). Though,

4
 anxiety is a common mental health concern among individuals of all ages and has an

abundance of literature, there are areas that could benefit from further exploration.

School Midwifery Kafanchan is a tertiary institution located at ST Louis Zonkwa , which

has an estimated number of 500 students and approximately 100 academic and non-

academic staffs. Early detection and prevention of mental health problems among student

nurses in colleges and universities is essential, understanding their psychological/distress

such as anxiety would allow appropriate screening and intervention programs to prevent

mental health problems in this populations.

1.2 Statement of the Study

Anxiety is a feeling of unease, such as worry or fear that can be mild, moderate or severe.

Everyone has feeling of anxiety at some point in their life. For example, you may feel

worried and anxious about sitting for an exam or a job interview. Feeling anxious is

sometimes perfectly normal however; people with severe form of anxiety find it had to

control their worries. Their feeling of anxiety is more constant and often affects their

performance or daily life.

Many sources of anxiety have been reported for some time by students which are often

times related to long hours of study, practical work and assignments among others. If a

student experiences an increased level of anxiety, the anxiety may have a negative effect,

resulting in decreased learning. These extreme levels of academic related anxiety may

cause some of them to even leave the programme.

Anxiety is one of the most prevalent mental health concerns for children and adolescents

(Essau, & Espnes, 2015). Anxiety can be extremely impactful for adolescents, given the

5
 importance of wellbeing during times of transition. Sources of anxiety can vary greatly.

Children and adolescents often experience anxiety when they have other psychological

disorders, if they are raised with anxious parents and during times of transition to name a

few. Treatment and awareness of anxiety can be essential in reducing the experience of

negative symptoms that can continue throughout one’s life.

School consumes a major part of children and adolescent’s lives and a significant portion

of their time. The school setting is highly connected to adolescents and their experience

with anxiety (Thompson, 2015). Troublesome anxiety can be exacerbated during the

school years as students face extreme transitions and social and academic pressures.

If teachers can better understand the anxiety levels of students, they will be able to

develop curricular and educational interventions to minimize the anxiety levels of

students. Hence, the need to investigate the factors responsible for anxiety disorders

among students of School Midwifery, ST Louis Zonkwa, Kaduna.

1.3 Purpose of this Study

The purpose of this study is to investigate the factors responsible for anxiety disorders

among students of School Midwifery, ST Louis Zonkwa, Kaduna. The specific objectives

of the study include:

1. To find out the factors responsible for anxiety disorders among students of School

Midwifery, ST Louis Zonkwa, Kaduna.

2. To investigate the effects of anxiety disorders among students of School Midwifery,

ST Louis Zonkwa, Kaduna.

3. To ascertain the strategies in minimizing and preventing anxiety disorders among

students of School Midwifery, ST Louis Zonkwa, Kaduna.

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1.4 Significance of the Study

The outcome of this study would benefit the government, school administrators,

psychologist and counselors, parents, public, and students. The findings of this study

would be of significant importance to the government in making educational decisions;

the studies would therefore provide government with evidence based data which would

help in making appropriate educational decisions and to ensure the reduction of anxiety

disorders among the learners at all levels of education.

Similarly, school administrators would find the findings of this study of great

importance in planning school activities and curriculum to ensure that all the variables

(anxiety disorders) advantages and disadvantages were incorporated for a smooth

school planning and administration.

The findings of this study would expose lecturers to understand how anxiety disorders

in particular can hamper the effort of l e a r n e r s to achieve high academic

Performance, thus exposing them of having the knowledge of who needs more

attention and why, how and when.

School psychologists and counsellors would find the findings of this study very

important because they could serve as key players in anxiety disorders

management, gender bias issues, mediators in giving family therapy, which would in

turn help improve learners‘ academic performance.

The findings of this study would be very important to the parents who were concerned

with their children‘s education and welfare. It would help parents to understand what

7
 they should do to minimize poor academic performance of their wards and also know

the symptoms and causes of anxiety disorders so as to take early precaution against

repeated episodes or severe anxiety.

1.5 Research Questions

1. What are the factors responsible for anxiety disorders among students of School

Midwifery, ST Louis Zonkwa, Kaduna?

2. What are the effects of anxiety disorders among students of School Midwifery, ST

Louis Zonkwa, Kaduna?

3. What strategies could be adopted in minimizing and preventing anxiety disorders

among students of School Midwifery, ST Louis Zonkwa, Kaduna?

1.6 Scope of the Study

The scope of this study focuses on the Factors responsible for anxiety disorders among

students of School Midwifery, ST Louis Zonkwa, Kaduna. It.is delimited on the factors

responsible for the anxiety disorders, effects and possible solutions to the anxiety

disorders within the study area.

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 CHAPTER TWO

REVIEW OF RELATED LITERATURE

This chapter deals with the review of related literature on the Factors responsible for

anxiety disorders among students of School Midwifery, ST Louis Zonkwa, Kaduna and is

discussed under the following sub-headings:

- Concept of Anxiety

- Factors responsible for anxiety disorders among students

- Effects of anxiety disorders among students

- Strategies in minimizing and preventing anxiety disorders among students

- Summary of Literature Review

2.1 Concept of Anxiety

Anxiety is a psychological and physiological state characterized by physical, emotional,

cognitive, and behavioural components. According to Jones (2017), anxiety means

trouble; in either presence or absence of psychological stress, anxiety can create a feeling

of fear, worry, uneasiness, and dread. It is considered to be a normal response to stress. It

may help an individual to cope with the demands of life but in excess it may be

considered as anxiety disorder reported that anxiety is a global problem affecting mainly

children and adolescents.

Combs (2018) reported that anxiety can occur as a result of stress, affecting learning and

memory and also affecting academic performance negatively. According to him, an

optimal level of stress can enhance learning ability and improve academic performance.

9
In contrast to fear, anxiety involves a more general or diffused emotional reaction -

beyond simple fear - that is out of proportion to threats from the environment. Anxiety is

defined by Richard (2016) as ‘a complex psychological and behavioural state.’

Walter (2015) opined that anxiety, an emotional state of a human during life is both life –

saving and also causes many problems in the mental life of human beings. Humans have

to always express inner struggles with different words, moods, feelings and emotions.

Therefore, in terms of the internal struggles, man uses expressions such as anxiety or

worry.

Anxiety is the most important factor of mental disorders based on the theory of

psychological analysis. Freud called anxiety 'emotional pain. This means the same as if

the body suffered from injury, inflammation and disease.

Anxiety according to Carter (2017) is the price paid for civilization. Anxiety surrounding

examination and other specific situations affects approximately 25% to 40% of

individuals with more females than males being affected.

Anxiety interferes with school functioning only when an abnormal level is reached,

where as within normal range, being anxious does not automatically imply worst school

functioning and indeed may to ascertain extent be motivating and enhancing to academic

performance, ranked anxiety into four levels: mild, moderate, severe and panic anxiety.

Anxiety is an intrinsic part of human nature and if we learn why something happen, it

usually becomes less frightening. Psychologists made a distinction between two basic

types of coping strategies which include problem focused strategies and emotion focused

strategy. Problem focused strategy attempts to deal with those aspects of environment

10
 that are responsible for stress and anxiety expression, that is dealing directly with the

stress situation while emotion focused strategy tends to change the way a person thinks

about a stressful situation.

In America, anxiety is the most common illness and approximately 40 million adults have

anxiety disorders. Carter (2017) observed that an optimal level of arousal and mindset is

necessary to best complete a task such as an examination, perform an act or compete in

an event. However, when the anxiety or level of arousal exceeds that optimal level, the

result is decline in performance. Hence the individual fails to fulfill the required

obligation.

Previous studies found that anxiety affected on students’ academic performance. The

concept is adopted from general term of anxiety and tried to apply in educational area,

mean that to gain the possibility of anxiety among students during study. According to

Sarason in Haris and Coy (2015) that anxiety is a basic human emotion consisting of fear

and uncertainty that typically appears when an individual perceives an event as being a

threat to the ego or self-esteem.

Spielberger theory of anxiety defined that anxiety as an emotional state consisting of

feeling, tension, apprehension, nervousness, and worry with activation or arousal of the

autonomic nervous system, these are differentiated as state and trait anxiety.

2.1.1 Academic Performance of Students

Academic performance is a term used to describe the rating of a student following an

examination. This is an important aspect of a student's life and is known to be influenced

by various factors including anxiety and level of hard work/preparations done prior to the

examination.

11
 Walter (2017) opined that academic performance is measured by the standing rates of

grades of students in every subject and students have their own attitude towards learning

and achieving a high level of academic performance. In order for a student to succeed he

needs to be armed with strategies and techniques that will supplement his desire to reach

his goals. One way is to have an efficient and adaptive study habit free of anxiety.

Philips (2015) stated that academic performance of nursing students can be determined

by various academic and non-academic factors that include measures of previous

academic performance such as college and high school grade point (GPA), scores of

different aptitude tests, and certain demographic characteristics such as age, gender,

marital status, ethnicity, residential background and previous work experience.

Furthermore, knowledge about predictors of academic performance help in developing

strategies to facilitate students' success in nursing education programmes and ensuring

adequate training and provision of man power in the nursing profession.

2.1.2 Anxiety and Academic Performance of Students

Anxiety symptoms are extremely common in childhood and adolescence and can

negatively interfere with general well –being, social life, academic performance and

development of social skills.

Adeyermi (2016) stated that anxiety symptoms are associated with impairment of

memory and cognitive functions and can contribute to poor school performance and

academic failure. Anxiety as illustrated by Holba (2015), plays important roles in our

lives. These include immediate reaction to stimuli following onset, anticipation and being

prepared for important events in the future. It may be unpleasant, but it is often adaptive

and in its absence one may have trouble as life becomes difficult to organize.

12
He further pointed out that anxiety can disrupt our lives if it becomes maladaptive.

However, Andrew (2019) explained that the consequences of anxiety during test or

examination may limit the educational or vocational development and promotion through

the educational system. It is normal for a student to feel anxious before a test or

examination, but it becomes problematic when the level of anxiety is excess.

Nwodo (2018) stressed that a variety of factors can contribute to a student's level of

anxiety, examples include: past experience with courses, perception of course load, their

inability to manage time, family issues and beliefs, which may have been shaped by a

complex interplay of factors, may result to a unique reaction to a situation and lead to

anxiety. The negative effects of anxiety can be explained by two models namely; the

Interference and the Learning Deficit Models. According to the interference model,

anxious students are distracted due to task irrelevant cognitions and negative thoughts

during examinations, while the learning deficit model proposes that it is student’s

ineffective study habits during preparation for an examination that causes them to be

anxious.

Researchers found that anxious individuals find it harder to avoid distractions and take

more time to turn their attention from one task to the next than their less anxious peers.

This makes learning, reading, remembering and writing difficult affecting academic

performance. Since, the anxious individuals perform at a comparable level to the non-

anxious ones with a greater cost in terms of effort or perhaps long term stress; it is

believed that students with high anxiety as well as those with low anxiety will have lower

academic performance. Therefore, those with moderate levels of anxiety will perform the

best (Lawan, 2018).

13
El-Rufa’i (2019), maintained that if an individual's experience is negative, then anxiety

level will be higher, leading to lower academic performance. Consequently, if an

individual's experience is positive, then the anxiety level will be lower leading to higher

academic performance. From these investigations, it has been observed that high and

lower levels of anxiety is related to poor academic performance while a moderate level of

anxiety is related to optimum academic performance.

Joel (2014) reported that chronic anxiety has a detrimental effect on academic success.

Every individual experience anxiety, although it most often ensues when the individual is

uncertain about an outcome. He further observed that about 30% of student nurses suffer

from anxiety especially in specific situations including: test, examination and

presentations.

According to Johnson (2017), the unfavorable effects of anxiety experienced by nursing

students leads to the development of low self esteem over a period of time which

adversely affects their academic performance.

Students of higher institutions have a great deal to create anxiety, especially in study

process. These are like difficulty of subjects, new roommates, identity crises, cultural

shock, and relationship problems in increase the anxiety. Anxiety disorders are rising

among students (Leta, 2017). But keep feeling anxiety could be interrupt students

‘performance. Individuals in high anxiety levels have experience symptom age during

university years.

Researchers found that many obstacles of anxiety while study processes such exam

anxiety, mathematic anxiety, language anxiety, social anxiety, family anxiety and library

14
anxiety. Anxiety while study is a major predictor of academic performance (McCraty,

2017) and various studies have demonstrated that it has a detrimental effect.

Researchers have looking at the correlation of anxiety sources and the effect of students’

academic performance, in term, students’ high level of anxiety achieved low academic

performance (Luigi, 2017).

High level of anxiety also interferes with concentration and memory, which are critical

for academic success. However, most of students would lack the concentration of study

because of exam anxiety, social anxiety, mathematic anxiety, and many anxiety sources.

Feeling discomfort and anxious in the classroom does not enhance learning of any kind.

The anxiety’s psychological symptoms among students include feeling nervous before a

study class, panicking, going blank during a test, feeling helpless while doing

assignments, or lack of interest of subjects difficult whereas the physiological symptoms

include sweaty palms, racing heartbeat, or an upset stomach.

Anxiety is a psychological and physical response to treat a self-concept characterized by

subjective, consciously perceived feelings of tension (Spielberger, 2015). Anxious

students have experience of cognitive deficits like misapprehension of information or

blocking of memory and recall. Speilberger reported two forms of anxiety: state anxiety –

a response to a particular stimulation or set of circumstances, and trait anxiety – an

intrinsic characteristic of the person. Previous anxiety research suggests that there are

roughly two types that can be experienced at different psychological levels (Hancock,

2015). Hancock concludes that students with high level anxiety show significantly less

motivation in classrooms perceived as highly evaluative compared to students with low

level anxiety.

15
 Study anxiety is not only due to the lack of study motivation or to insufficient skills, but

is also due to misperception about courses and negative experiences in previous study

classes. High level anxiety is more closely associated with lowered performance in low-

ability students than in high-ability counterparts (Hembree, 2018).

At the global level, anxiety is viewed as a permanent trait, as some people are

predisposed to be anxious. Previous studies found regarding anxiety disorders among

students such exam anxiety, but no studies about potential sources of study anxiety

among university student. Generally, study anxiety aimed individual perceive any anxiety

symptoms because of difficult situation while study process. The study aimed to identify

of study anxiety sources among university students.

2.3 Factors that cause students’ anxiety at higher Education Institutions

The Difficulty in Exams

Some students face anxiety with midterm and final exams because they are not well

prepared. Some students may not understand the exam questions and write the wrong

answers as a result. More importantly, sometimes there is not enough time to answer the

exam questions. Some faculty members do not know the differences in the students’

abilities, and they make exams that do not fit with some students’ intelligence. As a

result, students may fail the exams (Nwobodo, 2016).

Exam anxiety is widespread among college students in different majors like math,

history, geography, chemistry, physics, engineering, arts, and music. For example, some

16
students specializing in music have anxiety in exams where they must use a musical

instrument. Also, some pharmacy students have anxiety about their clinical exams.

Some students also face anxiety about online exams because some faculty members make

the exams with a time limit, and some students may need more time. Also, the computer

may not work well or Internet services may shutdown while students are taking the online

exam. As a result, some students may not prefer online exams.

Financial Pressure

Financial anxiety is considered an issue many students face when studying at higher

education intuitions because they are responsible for paying for their studies, especially

those at private institutions. Some of them may be in debt. This financial pressure leads

students to feel anxiety, which causes them psychological distress that results in a lower

Grade Point Average (GPA). Some students who face difficulties in understanding

difficult subjects depend on costly private instructors. Students also need money for daily

expenses such as food and transportation. When students feel they do not have enough

money, they may be anxious and ask friends for money, which negatively affects

students’ feelings, leading to stress and anxiety (Tony, 2017).

Studying a New Language

Studying a new language is a major factor that causes anxiety among many students,

especially those who follow their studies in a non-native language. Most students in

higher education institutions study English as a foreign language or as a second language.

Some of them may learn English before college. However, they may not able to meet the

17
high level of English proficiency required at the college level. They face anxiety because

if they cannot pass successfully, they may not be able to graduate from the institution.

The Curriculum Difficulty

Curriculum difficulties are also considered a factor that causes students’ anxiety in most

higher education institutions. Some students cannot understand the curriculum and

struggle to answer questions in the classroom, do assignments, and write research papers

or reports. Some students may hesitate to ask the instructors for help; therefore, they

become anxious because they are unable to meet the course requirements. Some difficult

curriculums include mathematics, biology, statistics, chemistry, physics, history, and law.

In addition, there are several medical specialization classes that cause students’ anxiety,

such as dental and medical, medical and engineering dentistry and veterinary, and

pharmacy (Madaki, 2016).

Culture Shock

Many international students suffer from alienation and culture shock when they seek to

continue studying in other countries. This shock causes them psychological crises such as

anxiety because of the distance from their family and country, the difficulty of a new

language and speaking with others, and the difficulty of adapting to the new culture,

which requires patience.

Family Responsibilities

Some university or nursing students have many family problems that cause them anxiety

while they are studying. One of these problems is the illness of a family member, such as

a parent, which requires the student to remain close to the patient. If the students have

18
responsibility of the children and the husband. These problems affect the student

academically because it hinders him in preparing well for tests, performing academic

duties, and attending lectures, which causes him concern about how to balance his family

and academic responsibilities.

Illness

Some students who suffer from a chronic illness have anxiety. For example, a student

who suffers diabetes is required to take daily insulin injections and go to the health

center, and some may experience dizziness while at the university campus. Diabetes may

hinder a student if his health condition relapses, and he may be absent from the

university. Other illnesses include cancer, anemia, heart problems, asthma, and obesity.

These diseases may negatively affect the academic level of the students, which causes

them anxiety.

Employment

Some students who attend higher education institutions work off campus part or full time.

Some of them may not be able to attend classes, specifically if they work in the mornings

and their classes are scheduled for the same time. Some of them face anxiety if they

cannot manage their time. They may fail their courses because of their absences or fail

exams because they do not prepare well (Philips, 2016).

Discrimination

Discrimination is a concern that many students face at higher education institutions. The

institutions gather students and staff from different backgrounds, nationalities, ethnicities,

religions, colors, cultures, and levels of intelligence. Some students feel anxiety because

19
 of unfair treatment from classmates, friends, and staff and faculty members. When the

students feel they are not welcome and they are treated badly, this causes them to feel

anxiety.

Disabilities

Some disabled students enter higher education institutions to further their studies, despite

the challenges they face. Some disabled students have anxiety because they are unable to

major in some specializations they may need. Some specializations such as geology and

biology need students to participate in course activities using labs and instruments, which

is difficult for some disabled students. Also, they may not be able to socialize with other

students and may prefer isolation (Mbafo, 2017).

Some students are visually impaired and require specific resources like certain textbooks,

handouts, and software. However, these resources are not available for some courses.

Also, some students may have psychiatric disabilities and need special attention from the

mental health center to help them succeed academically. Some students who have autism

spectrum disorder have anxiety when trying to achieve success in their academic studies.

2.4 Effects of Anxiety

The symptoms of anxiety can interfere with functioning at any stage in life. For students,

this interference is particularly important because they are in school learning the skills to

become successful adults. Wit (2017) suggested that students with mental health concerns

might become neglected by teachers and rejected by peers, possibly escalating the mental

health concerns because of decreased perceived support. The transitions students

encounter as a normal part of development often lead to decreased motivation, academic

20
performance, and self-perceptions when they struggle with anxiety. Students who are

distracted by anxiety symptoms struggle to focus on class work, worry excessively,

experience physiological arousal, stomachaches, headaches, often poor attendance, and

subpar performance (Bostick, 2016).

Specifically, poor attendance can lead to school dropout and adulthood health, social, and

economic problems (Ingul, 2016). Considering test anxiety exclusively, student’s anxiety

interferes with thoughts, feelings, and behaviors that impact test results. These test results

then reinforce student’s anxiety about performing well, perpetuating the cycle of anxiety.

Anxiety sufferers have lower self-efficacy and can have difficulty regulating their

emotions. Anxious students may also be at greater risk for depression, addiction, eating

disorders, and suicidality. As part of the increased responsibility and independence

students receive, as they get older, emotional support often decreases in secondary

school. It has been found that anxiety symptoms can escalate when emotional support

decreases. When anxiety is constantly getting in the way for student’s overall

functioning, they tend to have psychosocial difficulties and school can be a difficult place

for them to be.

When students have anxiety, it affects their mind and body and causes several symptoms:

cognitive, physical, and emotional.

Cognitive symptoms

Many students could experience symptoms along with their feelings of anxiety. They

may have many negative and painful experiences, such as insomnia and other sleep

21
disorders. Anxiety also negatively affects students’ memories. They may become unable

to think correctly and make decisions; therefore they cannot participate in classroom

discussions and cannot share their opinions and ideas with other classmates and faculty

members. Some of them feel sadness, fear, and panic. As a result, their academic

achievements are negatively affected.

Physical Symptoms

Students with anxiety can experience significant pain with symptoms like breathing

problems, stomachaches, headaches, joint and muscle pain, and fatigue. These symptoms

could make them unable to come to the university. Some students may fear from the

faculty, so they upsent from the institution. Some students become fatigued when they

have a lot of academic work to do on campus and feel anxious because they do not know

how to manage this work. This academic anxiety badly affects students’ health; however,

they should cope with anxiety. Some students have sensitive behaviors, which play a role

in their tendency to become overwhelmed with anxiety. This needs change for students to

cope with academic life (Jones, 2016).

Emotional Symptoms

Some students who suffer from anxiety experience painful emotional symptoms such as

depression, sadness, nervousness, anger, and loneliness. Students may feel unhappy about

coming to a university or become very nervous around people, such as friends and peers.

Others feel worried and sad when they cannot overcome the challenges they face, such as

having a low GPA. Some of them like to be alone when they have stressful feelings,

which can lead to depression. Sometimes, these students may have negative thoughts

22
about withdrawing from college, especially when their friends are successful and have

good GPAs. Some students may feel tired from studying, the tough curriculum, and

attending the university. They may have expected to be happy with university life but

instead found it to be the opposite of what they wanted.

The effect of anxiety on academic performance as revealed by (Richard, 2018) is not

always obvious and new research funded by the Joel suggests that there may be hidden

costs. The research found that anxious individuals find it harder to avoid distractions and

take more time to turn their attention from one task to the next than their less anxious

peers. He further stated that a lot of the negative effects of anxiety appear to be caused by

difficulties with controlling attention. This suggests that training techniques designed to

enhance attention; control the ability of students to ignore distractions and prevent the

switching of their attention from one task to another could help anxious students to

achieve their academic potential.

Tony (2018) also showed that anxious individuals often perform at a comparable level to

non-anxious ones but only do so at a greater cost in terms of effort or perhaps long term

stress. This implies that it is important that teachers focus not only on whether a student’s

academic performance seems to be satisfactory but also on how much effort the student

had to put in to achieve that level of success. Anxious students may be trying desperately

hard just to keep pace with academic demands and this could be at great psychological

cost.

It is when anxiety is in its severe form that some students experience genuine problem in

academics. Their minds go blank, they experience the shakes, their hands go numb and

they suffer from a number of sudden disabilities associated with anxiety during

23
 examination. Academic performance is the outcome of education. It refers to the extent to

which a student, teacher or institution has achieved their educational goals. This goal is

known to be influenced by anxiety.

2.5 Strategies to Alleviate Students’ Anxiety

Mental health problems are a social phenomenon that requires attention in many

societies. Anxiety is an aspect of a college student’s mental health. Attention must be

paid to the means that help prevent students from falling into anxiety and reducing its

severity and psychological impact on the students continuing their studies.

Improving relationships between faculty members and students

Having human relationships between faculty members and students is very important.

Communication between these groups plays an important role in reducing students’

anxiety. The faculty members should ask students if they need help to understand the

curriculum, do assignments, and write reports. The faculty can design class activities

related to the curriculum to make sure the students understand the content. For example,

in teaching a language, the faculty should encourage group work in class to help students

participate in communication to improve their speaking and their relationships with

classmates to reduce the anxiety. Also, video games online can improve communication

among students, increase students’ confidence, and reduce their anxiety collaborative

work among students can also reduce students’ anxiety, and they should be encouraged to

use the strategies they prefer in learning.

The faculty members have important roles in guiding students and giving them advice

related to academic decisions, such as selecting a college or selecting a major, and

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helping them manage their time for studying multiple curriculums. In helping them deal

with anxiety, adapt to the challenges, and improve their thinking, faculty members can

reduce anxiety’s psychological side effects on students’ bodies and minds.

Using Mental Health Services

Many institutions provide students with mental health workers to help them cope with

their negative feelings while they pursue their studies. To provide students with efficient

mental services, the institutions should hire workers who specialize in psychology and

counseling. This will provide students with effective strategies to reduce their anxiety.

These mental health workers should be available to meet students on campus and, most

importantly, give students a trusted and secure setting in which to improve their self-

confidence when they seek help. They should provide students with a socialized

atmosphere to reduce their isolation and fear, specifically students with psychiatric

disabilities and autism spectrum disorder. These students need to manage their social

emotions to adapt to university (Adeyemi, 2017).

Also, it’s important to provide international students with mental health workers who can

deal with their culture shock, speak different languages to meet various students’ needs,

and provide them with social support and a friendly relationship. Different social and

cultural activities on campus can help students communicate with others and reduce their

anxiety as well.

Improving Academic Services

To reduce students’ academic anxiety, institutions should provide students with effective

academic services like a writing center, which helps students, write in many subjects and

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improves their efficiency in using vocabulary and grammar. Tutorial services are also

important in helping students reduce their anxiety. The tutorial should be provided by an

effective staff specializing in the curriculum to help students understand the content of

the courses, specifically in language courses, mathematics, statistics, and biology.

Improving library services can help students do research and experiments. According to

Grandy (2016), some nursing students have library anxiety because they are unable to use

the library services. Therefore, these students should be provided with information

literacy courses to reduce their anxiety about using library resources, technology

resources, and searching strategies.

Physical Exercise and Relaxation Activities

Many students who suffer from anxiety can manage their negative feelings through

exercises like walking, swimming, and playing tennis. Some students join sports clubs,

which results in an improvement in their positivity and happiness. Taking part in physical

activities can greatly reduce the negative psychological health impacts on a student’s

body and mood, reduce mental difficulties, and improve their health well-being. Other

students may prefer to reduce their anxiety by reading books about mental health and

dealing with anxiety to be aware of how they can manage their symptoms (Aminu, 2016).

The School Setting and Interventions

The school setting offers the opportunity to assist students with anxiety concerns. Miller

(2014) proposes the idea that providing mental health services in schools can be

beneficial by reaching a large number of students at one time. They also suggest that

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linking mental health services and academic settings could help create a favorable

environment to improve overall success and achievement.

Bostick and Anderson (2015) discuss the importance of removing barriers, such as

anxiety and other mental health problems, in school settings to increase performance.

Ingul (2016) studied school absenteeism and its relation to multiple risk factors, including

anxiety. They found that adolescents who have internalizing problems, such as high

social anxieties, tend to have no or normal absences from school, whereas students with

externalizing problems have higher rates of absenteeism. This suggests that the students

suffering from internalizing anxiety are in school and available to receive support in

dealing with their problems. In schools, referrals from parents and teachers often help

students deal with anxiety, one of the most prevalent forms of psychopathology that

occurs in this age group. Students frequently present with academic, behavioral, and

social concerns, which are masking anxiety and result in application of ineffective coping

skills.

Understanding the prevalence of student anxiety will assist in using the opportunity of the

school environment to recognize and address students’ mental health concerns. Wit

(2015) stated that teachers are in a position to provide a sense of security for students to

explore the world, experiment and take risks, and learn emotional regulation and coping

strategies.

Similarly, Martinez (2017) findings suggest that a positive school environment inclusive

of supportive aspects promotes adolescent’s wellbeing, healthy development, and

positive learning experiences. Lothmann et al., (2017), claim that long-term anxiety

prevention begins with understanding the individual’s anxiety early on.

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 Various research studies have been conducted on in-school interventions to help manage

student anxiety. Overall, results suggest providing students with knowledge and coping

skills promotes wellbeing, achievement, and lower levels of anxiety. Adolescents often

use coping strategies that include pessimistic thinking and rumination.

More specific interventions have also been explored in existing research. School wide

programs such as FRIENDS for life, which includes cognitive behavioral therapies in a

classroom curriculum, has been shown to be effective in teaching children to recognize

signs of anxious feelings, irrational thoughts, and maladaptive behaviors.

2.6 Summary of Review of Related Literature

The research work has reviewed the factors responsible for anxiety disorders among

students of School Midwifery, ST Louis Zonkwa, Kaduna. The review has covered the

causes of anxiety disorders, its effects and solutions among others. Anxiety can occur as

a result of stress, affecting learning and memory and also affecting academic

performance negatively. An optimal level of stress can enhance learning ability and

improve academic performance. Many studies have revealed that student’s performance

in schools, college and universities are affected by symptoms of anxiety which may

interfere with their academic achievement and affect their future employment.

Various strategies were applied to reduce the predisposing factors responsible for anxiety

disorders yet, it is the concern of the researcher to attempt to embark on a similar issue to

provide solutions to the identified problems of anxiety disorders in order to fill the gap in

the study area.

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 CHAPTER THREE

RESEARCH METHODOLOGY

This chapter presents the machineries used in collecting and analyzing the relevant and

the materials required for the purpose of the purpose of this investigate study. The

following methods have been considered appropriate and used in collecting data for this

research work. Research Design, Area of the study, Population of the study,

Sample/Sampling technique, Instrument for Data Collection, Validity of the instrument,

Reliability of the instrument, Method for Data Collection and Method of Data Analysis

3.1 Design of the Study

This study adopted descriptive survey research design to determine the Factors

responsible for anxiety disorders among students of School Midwifery, ST Louis

Zonkwa, Kaduna seeks the opinion of people regarding the issues under investigation,

(Blair, 2017). This design is also considered suitable and appropriate because Combs

(2015) defined survey design as studies conducted by collecting and analyzing data from

a sample representing the entire population and the result obtained from the sample can

be used to make generalization.

3.2 Area of the Study

The research work will be conducted at School Midwifery, ST Louis Zonkwa, Kaduna.

School Midwifery, ST Louis Zonkwa came into existence in 2010 in a move to bring

government very closer to the people.

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3.3 Population of the Study

The target population of the study consisted of all students of School Midwifery, ST

Louis Zonkwa, Kaduna. The accessible population of 150 respondents will be sampled

out for the study.

3.4 Sample and Sampling Techniques

For the purpose of selecting the sample for this study, one hundred and fifty (150)

respondents will be randomly selected from the population of the students using stratified

sampling technique.

3.5 Instrument for Data Collection

The researcher will develop a structured questionnaire for the study made up of four

sections. Section “A” deals with the Demographic data of the respondents. Section B

deals with the factors responsible for anxiety disorders among students of School

Midwife, Section C deals with the effects of anxiety disorders among students of School

Midwifery and Section D deals with the strategies in minimizing and preventing anxiety

disorders among students of School Midwifery. A four point Likert rating scale will be

used to permit decision. Thus, SA- Strongly agree, A- Agree, D- Disagree and SD-

Strongly disagree.

3.6 Validation of the Instrument

Face validity and content validity of the research instrument will be established by the

researcher. In order to achieve this, the researcher constructed the instrument reflecting

the variables under investigation. Also, the items in the instrument will be based on the

specific objectives, and the researcher will give the developed tool to the supervisor for

modification of items, assessment and approval of the instrument.

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3.7 Reliability of the Instrument
Reliability refers to the consistency with which an instrument measures what it is

supposed to measure. The reliability is done using test-retest method. Here the researcher

give 20 questionnaires to the respondents who were not part of the study. Thereafter, the

same sets of questionnaires will be administered to the same respondents after three (3)

week and the two tests will be correlated and the reliability co-efficient of 081 is

expected to be arrived at.

3.8 Method of Data Collection

The questionnaire will be administered to the subjects face to face with the help of a

research assistant. One hundred and fifty (150) questionnaires will be administered to the

respondents to obtain their responses on the subject matter.

3.9 Method for Data Analysis

The mean statistic will be used to analyze the data collected. Decision rule is used to take

decision. The response from each section of the questionnaire is analyzed by computing

the statistical means of each item. Each mean is interpreted to the real limits of the

normal value of the scale used for data collection. A cut off point of each item of 2.5 and

above is used to accept an item. Any item with a mean score equal to or greater than 2.5

will be accepted while any item less than that will be rejected.

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 Appendix 1
Department of Primary Health Care Education,
College of Vocational and Technical Education,
Kaduna Polytechnic,
Kaduna.

QUESTIONNAIRE ON THE FACTORS RESPONSIBLE FOR ANXIETY DISORDERS

AMONG STUDENTS OF SCHOOL MIDWIFERY, ST LOUIS ZONKWA, KADUNA

This questionnaire is designed to determine the Factors responsible for anxiety disorders among

students of School Midwifery, ST Louis Zonkwa, Kaduna.

Your view on this issue is of great importance and your response would be highly appreciated.

The information on the questionnaire is strictly use for research purposes therefore,
confidentiality is assured.

SECTION A : ON PERSONAL DATA OF THE RESPONDENTS

1 Age : 18-25 years ( ) 26-35 ( ) 36 years and above ( )

2 Gender : Male ( ) Female ( )

3. Marital Status: Married ( ) Single ( ) Separated ( ) Divorced ( )

Widowed ( )

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What are the factors responsible for anxiety disorders among students of School
Midwifery, ST Louis Zonkwa, Kaduna?

SECTION B

S/N Options SA A D SD
1 Financial Pressure
2 The Difficulty in Exams
3 The Curriculum Difficulty
4 Employment
5 Illness

SECTION C

What are the effects of anxiety disorders among students of School Midwifery, ST Louis
Zonkwa, Kaduna?

S/N Options SA A D SD
6 It leads to decreased motivation
7 Self-perceptions when they struggle with anxiety
8 Worry excessively
9 Experience physiological arousal
10 Stomachaches

11 often poor attendance

12 Students who are distracted by anxiety symptoms
struggle to focus on class work.

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SECTION D

What strategies could be adopted in minimizing and preventing anxiety disorders

among students of School Midwifery, ST Louis Zonkwa, Kaduna?

S/N Options SA A D SD
13 Authority to adopt appropriates measures
14 Improving relationships between faculty members
and students
15 Physical exercise
16 Improving academic services
17 School setting and interventions
18 Teachers can better understand the anxiety levels of
students.
19 To develop curricular and educational interventions
to minimize the anxiety levels of students.
20 To have relaxation activities

34