CHAPTER FOUR

DISCUSSION

This study access the prevalence of generalized anxiety disorder on socio-

demographic factors of among distance learning (DLI) students of the University of

Lagos (Unilag). Specifically, the five major objectives of this study are, first, to

identify the prevalence of generalized anxiety disorder of (DLI) students, second, to

determine the significant difference of scores on generalized anxiety disorder scale

between male student and female students of the distance learning institute (DLI),

thirdly, to determine if there would be a significant difference between the level of

education on the score of generalized anxiety disorder among distance learning

institute (DLI) students of university of Lagos, fourthly, to identify the significant

difference between marital status on the score of generalized anxiety disorder among

distance learning institute (DLI) students of university of Lagos. finally, to identify

the significant difference between age group on the score of generalized anxiety

disorder among distance learning institute (DLI) students of university of Lagos. Five

hypotheses were tested and these hypotheses are the main focus of the discussions in

this chapter.

The study revealed that there is a moderate prevalence of generalized anxiety disorder

among distance learning institute (DLI) student of the university of Lagos. This is not

consistent with many studies from around the world (Rahman, et al., 2013; Alzahrani,

et al., 2017; Hakami, et al., 2018; Ibrahim & Abdelreheem, 2015). A large number of

previous studies from different countries utilizing diverse study populations, including

distance learning students, have investigated the prevalence of anxiety (Rahman, et

al., 2013; Alzahrani, et al., 2017; Hakami, et al., 2018). The prevalence of anxiety in
this study was found to be higher in comparison with other studies; for example, a

recent study by Ibrahim and Abdelreheem (2015) using a sample of (n = 164)

working class students from Alexandria University reported 29.3% of the prevalence.

Similarly, another study from Saudi Arabia estimated the prevalence of anxiety and

depression among distance learning students (n = 239) using a cross-sectional design

and reported a prevalence of 14% among working students and 23% among

nonworking students (Alattas & Alkhalawi, 2017). Another study by Bayram and

Bilgel in 2018 among Turkish university students (n = 1617) found 47.1% of anxiety

(Bayram & Bilgel, 2018). Consistently, another study by Shamsuddin et al. among

Malaysian students reported 34% of anxiety (Shamsuddin, et al., 2013). Our study

findings were lower than a previous study by Yusoff et al. among undergraduate

students (n = 442) who reported a high prevalence of anxiety of 64.3% (Yusoff, et al.,

2017), although previous findings suggested that a high prevalence of anxiety (7.7%

to 65.5%) among distance learning students were reported in American and European

students (Quek, et al., 2019). However, the prevalence of anxiety may differ among

gender, age group, educational year, and academic curriculum (Alzahrani, et al.,

2017; Hakami, et al., 2018; Ibrahim & Abdelreheem, 2015). This might be the reason

for the moderate prevalence of anxiety in this current study

According to the results of the present research, GAD had a prevalence of 23.7% in

the population studied, which was lower than the level reported in the general

population. Some of the causes of this high GAD level in the students, especially

those studying and working included a professional encounter at work, plus the

tending to family and change of sleeping pattern for those working shifts (Berger, et

al., 2021). On the other hand, students are prone to psychological disorders, especially

anxiety disorders, due to their special situations, including being away from the
family, entering large and stressful complexes, having economic problems and

insufficient income, and dealing with a high volume of courses and intensive

competitions (Rovira, et al., 2020; Labbafinejad & Bossaghzade, 2020).

Previous research has shown that an increased prevalence of anxiety among distance

learning students is to be expected (Mayer, et al., 2016; Yusoff, et al., 2013; Hope &

Henderson, 2014; Chernomas & Shapiro, 2013). There are many factors that can

explain this, such as sociodemographic factors. This study found a high prevalence of

mild-to-severe GAD among these students (n=156, 67.5%); this is similar to the

anxiety prevalence (54.5%) that another study reported among medical students

(Yusoff, et al., 2013). The mean total score on the GAD-7 was 7.18 ± 4.8 (mild

anxiety), which was also consistent with previous studies (Yusoff, et al., 2013;

Bayram & Bilgel, 2018).

In the study of Mahmoud, et al., (2020), the prevalence obtained for the presence of

depression, anxiety and stress among students were 62.6%, 67.8% and 17.8%

respectively. This showed that prevalence of depression and anxiety are higher in

comparison to that of stress among the distance learning students of Oduduwa

University, Ile- Ife, Nigeria (Lamidi, 2016). This prevalence is higher compared to the

one obtained among university students in Turkey where the prevalence of

depression, anxiety and stress were found to be 27.1%, 47.1% and 27.0%,

respectively (Bayram and Bilgel, 2018). Similarly, the result of this study was also

higher than that obtained by Shamsuddin et al (2013) who obtained prevalence of

37.2%, 63.0% and 23.7% for depression, anxiety and stress respectively in their study

among Malaysian university students. This shows that prevalence of depression and

anxiety are existing in higher rate among the undergraduate student as compared to

some other environment outside Nigeria.

Furthermore, this result was not similar to studies conducted at the Australian

National University (Farrer, et al., 2016) and Yale University (Han, et al., 2013), with

the prevalence risk of anxiety was at 17.5 and 29%, respectively. Nonetheless, higher

anxiety was reported by Nour et al. (2016), where 62.4% of the students who

participated in their study showed a potential risk of having anxiety, with 28.7% of

them having clinically significant anxiety. Similarly, a study conducted among

Portuguese college students also depicted a higher prevalence of anxiety (32.8%)

(Bártolo, Monteiro & Pereira, 2017). Based on the multivariate analysis, academic

year, financial support for the study, alcohol consumption, poor sleep quality, body

mass index (BMI), having a good friend(s) in the university, having doubt regarding

the future, actively involved in the society, and having a problem with other students

and lecturer(s) were found to be significantly associated and were the predictors for

the risk of anxiety in our study.

Secondly, the result of this study also revealed that female student of the distance

learning institute (DLI) would score significantly high on generalized anxiety disorder

scale than the male students. In line with previous studies (Khoshhal, et al., 2017;

Kulsoom & Afsar, 2015; Auerbach, et al., 2018), the prevalence of GAD was slightly

higher in female students, compared to male students. Nonetheless, this difference

was statistically insignificant. The possible causes of the difference between male and

female students in terms of the prevalence of GAD included the difference in brain

structures (Khamirchi, et al., 2015), hormonal differences (Sadeghian & Heidarian

Pour, 2019), the role of the menstrual cycle (Ingalhalikar, et al., 2013; Altemus,

Sarvaiya & Epperson, 2014), and type of coping strategy (e.g., avoidance coping

style, that is mainly used by women and is determined by denying or avoiding a

stressful situation, is closely related to psychological pathology) (Nillni, Rohan,

Zvolensky, 2020).

In the study of Spitzer, et al., (2016), female students were more anxious than their

male counterparts. The mean score for female students was 8.06 compared to 6.67 in

male students, with no significant difference (p> 0.05). These findings were similar to

those reported by previous studies performed in Egypt (Naeinian, et al., 2021),

Turkey, and Hong Kong that found high levels of anxiety and stress among women

(Naeinian, et al., 2021; Wittchen, 2020). In contrast, other researchers have found no

significant association between psychological disorders and gender (Berger, et al.,

2021).

GAD occurs more commonly among women, with a lifetime prevalence of nearly 7%

for women in community samples, compared with about 4% for men (Kessler, et al.,

2019). The rate of GAD is particularly elevated among women 44 years of age and

older (Kessler, et al., 2019; Alahmadi, 2019). The 14-country WHO study found an

average current prevalence of 9.2% among women and 5.7% among men, although

gender-specific rates varied substantially among the study sites. In Brazil, for

example, the current prevalence of GAD was 26% for women and 14% for men,

whereas in China it was 2.1% for women and 1.7% for men, which suggests that

cultural and/or genetic factors may contribute to diagnostic prevalence (Vaingankar,

et al., 2020).

Furthermore, a study conducted at the University of Alabama in the United States

found that both state and trait anxiety levels of male students are statistically

significantly lower than that of females students (Misra & McKean, 2020). Research

from Dhaka University in Bangladesh also found that females have higher anxiety
levels (Khanam & Rahman, 2013). Additionally, studies conducted in Brazil and at

Jefferson Medical College in the United States confirm these findings (Andrade, et

al., 2021; Hojat, et al., 2019). In a study conducted on university students in Australia,

Butler (2015) found that depression, anxiety, and stress among males were lower than

that among females. Our research produced similar findings. One explanation for the

gender differences in anxiety may be that girls have equal opportunities in the Turkish

university setting. Perhaps, compared with boys, girls must exert more effort than

their male peers to gain a respectable position in the society.

Mohammadi, et al., (2013) study also revealed that female students obtained

significantly higher scores on anxiety than did their male counterparts. This finding

agree with the findings of other investigators who also found that females suffered a

higher level of anxiety or social anxiety (Somers et al., 2016; Eisenberg et al., 2017;

Ostvar & Taghavi, 2016). Conversely, some studies demonstrated higher lifetime

prevalence rates for social phobia (Wells et al., 2019) and obsessive compulsive

disorders (OCD) (Bijl et al., 20188) in men as compared to women. Some other

studies again failed to find any significant differences with regard to anxiety among

female and male students (Khan et al., 2006; Inam et al., 2013).

The possible reasons for high female anxiety are explained by Verbuegge (2015),

namely that females are more likely to report concerns about the volume and

complexity of the study material they have to cover, they are more likely to report

stress due to self-expectations and a feeling of lack of competence, and women tend

to over-report medical and psychological symptoms. Iranian women are likely to

experience symptoms of psychiatric disorders, possibly due to social and cultural

limitations imposed on them. Higher anxiety among females than males may be due

to physiological factors and the sex roles of women in social and interpersonal
relationships. Female physiology entails that women go through hormonal change and

that they may experience problems in the reproductive age (coupled with childcare),

or when they reach menopausal status in their life. Women are at risk of mental

disorders due to the robust effect of biological factors or because of greater social

inconveniences. However, the type of social problems may differ between cultures

(Chiu, 2014). According to Noorbala (2021), social difficulties, physiological factors,

stress caused by the environment and marriage are important risk factors for mental

disorders among women.

Regarding gender, there is cumulative empirical evidence in support of women having

higher anxiety scores compared to men. Our findings are consistent, for example, with

those of Balanza, Morales, and Guerrero (2019) as far as females who display an

increased risk of anxiety. These authors, motivated by the high number of pupils

attending counseling hours and tutoring, performed a study that included 700 students

from a multistage random cluster sample at the Universidad Católica San Antonio de

Murcia (Saint Anthony Catholic University) and measured anxiety and depression

symptoms using the Goldberg scale.

The third result showed that there is no significant difference between the level of

education on the score of generalized anxiety disorder among distance learning

institute (DLI) students of university of Lagos. This is similar with the study of

(Yusoff, et al., 2013; Bayram & Bilgel, 2018) which revealed that there was no

significant association between academic year and level of anxiety. Although

Alzahrani, et al., (2017) reported that upperclassmen in a sample of university

students scored the highest on anxiety and depression. Another study on university

students found that first-year students were the most anxious and anxiety then

decreased until the sixth year (Auerbach, et al., 2018).

The academic year showed the strongest association with risk of anxiety among

university students in Malaysia. The significant relationship between anxiety and

academic year can be contributed by several factors such as different approaches by

each course, variation in assessment and grading system of each course and

differences of teaching methods in the different academic years (Kessler, et al., 2019;

Alahmadi, 2019). A study has been reported that students in their early university

years had difficulty adjusting to the new university life and having problem to handle

everything independently (Shamsuddin et al, 2013). Also, our data was inconsistent

with a study conducted among engineering students in one of the public university in

Malaysia, where, in their study, it showed that as the number of the academic year

increased, the anxiety level among the students increased as the course becomes

harder, and their workload increases (Alattas & Alkhalawi, 2017). The probable

reason for the variation of data between studies can be due to factors such as sampling

methods, sample size, the differences of the instrument used and the way the data was

interpreted (Labbafinejad & Bossaghzade, 2020).

Most of the students in the research of Rettek (2020) were newly enrolled students

(first and second-year students, 95.2%), as compared to senior students (third and

fourthyear, 4.8%). This could well explain the high anxiety levels found. Inam et al.

(2013) agree with this finding and also report a higher prevalence of anxiety and

depression among newly enrolled (first and second-year) students than among senior

students. According to Rettek (2020), newly enrolled students are confronted with

more stress and anxiety, which affect their performance. Factors such as unfamiliarity

with a university environment may lead to mental disorders for first-time students or

increase their mental problems and reduce their performance. For most students this

was the first time that they were away from their family, and their own dissatisfaction
with the course of study that they had registered for, an inability to adjust among other

students and insufficient income could well lead to anxiety.

Fourthly, the result showed that there is no significant difference with marital status

on the score of generalized anxiety disorder among distance learning institute (DLI)

students of university of Lagos. This contradicts many studies that examines the

anxiety level of married students compared to the unmarried students (Kaya, et al.,

2017; Hovey and Seligman 2017; Kessler, et al., 2019)

Married students reported higher stress compared to single students in only two areas,

those related to academic and research performance. Marriage can bring massive

social support that can mediate positive influences towards an academic career and act

as a buffer during times of stress (Kaya, et al., 2017). It was also interesting to note

that while single students were more stressed about items related to future goals, the

married ones were stressed on items related to immediate goals within their degree

programme. Over all, for postgraduate students, social support network/s in the form

of marriage can provide an effective means to overcome stresses of academic and

personal nature.

This finding is in line with Turley and Desmond’s (2021) study in which those raised

by divorced or widowed parents only had one or no parental figure living with them.

These conditions forced them to grow up faster, be less dependent, and learn to take

care of themselves. Furthermore, they had greater burdens such as having housework

responsibilities and taking part-time jobs to improve their family’s financial

condition. Hovey and Seligman (2017) found that proper family support can be a

protective factor of anxiety and depression. Moreover, Taylor (2018) explained that

adequate family support makes people feel loved, respected, and cared for. Although
having married parents does not guarantee proper family support, those raised by

married parents had a higher probability of having adequate social support from their

family.

Finally, the result showed that there is significant difference with age group on the

score of generalized anxiety disorder among distance learning institute (DLI) students

of university of Lagos. The mean score for the participants aged 41 and above were

significantly higher than other age group. There has been inconsistency in relation to

other results as the study of Kessler, et al., (2019) showed no statistical significant

relationship between age, gender and the mean anxiety and stress scores among the

students. This result is similar to that obtained by Lester (1990) in his study among

college students. He reported that significant relationship was found between age and

anxiety scores.

However, significant relationship was present between anxiety and age in the study of

Berger, et al., (2021). These findings correlate with the findings of other investigators.

Somers et al. (2016) demonstrate a slight decrease in prevalence of anxiety with

increasing age. Eisenberg et al. (2007) found that the characteristics associated with

fewer mental health problems included being older than 25 (compared to being

between 18 and 22) among university students. In contrast to the above results, when

all anxiety disorders are taken into account, an increase in lifetime prevalence from

ages 18 to 64 years is found. Most of the literature regarding risk factors among

students have focused on the risk of anxiety, and also found a higher risk of suicide

for students of 25 years or older for male undergraduates (Silverman, 1997).

However, no age effect was found by Ollendick et al. (1991).

Furthermore, Labbafinejad & Bossaghzade, (2020) found that younger students and

those enrolled in early semesters showed greater anxiety symptoms than older

students, and these were significantly different. It was also found that, although it is

not high, there is a negative correlation between the age group of the participants and

the total score of the BAI; this means that the younger the student, the more anxiety

symptoms he/she exhibits. Literature reflects that first-year college students face more

challenges in their effort to adapt to their new lives, being away from their old friends

and families, and sometimes the stressful environment of certain schools, like the

distance learning (Roy, Sai & Doshi, 2015).