Content uploaded by Alliu Sadiat Iyabode
Author content
All content in this area was uploaded by Alliu Sadiat Iyabode on Jan 07, 2025
Content may be subject to copyright.
1
Stress-Health Relationship and Culturally Relevant Intervention Strategies for Selected
Cases in Nigeria.
Alliu Sadiat. Iyabode, Department of Psychology, University of Ilorin, E-mail:
alliu.si@unilorin.edu.ng
Amao Abdulrazaq Idowu, Department of Political Science, Christopher University, Mowe
amao.abdulrazaq.idowu@gmail.com
Cite: Alliu S. I, & Amao A. I. (2024). Stress-Health Relationship and Culturally Relevant
Intervention Strategies for Selected Cases in Nigeria, Christopher University Journal of
Management and Social Sciences (CUJMSS) | 4(2) JUNE, 2024, 69-79
Abstract
This study explores the significant effects of stress on health through a comprehensive literature
review of studies and theoretical frameworks that highlight the psychological, physiological,
immunological, and neuroendocrinological mechanisms underlying the stress-health relationship.
Through in-depth interviews with a few samples of students, the study examines individual
experiences of stress and their subjective interpretation of the impact of stress on their health.
Findings suggest that stress has a significant impact on the student’s health and well-being,
manifesting in physical symptoms, compromised immune function, psychological distress, and
disruptions in hormonal balance. The study identifies key factors influencing the stress-health
relationship and recommends that universities should improve their mental health awareness
programs by incorporating culturally relevant intervention strategies that take into consideration
the student’s special experience, needs, and individualized support to promote their health and
wellbeing. The ramifications are profound for school counselors, policymakers, and healthcare
professionals, implying a paradigm change toward holistic, culturally sensitive health practices
and policies that place equal emphasis on physical and mental well-being.
Keywords: Stress, Health, culturally relevant, Intervention-Strategies,
Introduction
Scientific findings have established a link between stress and health, establishing that stress is a
response to perceived threats or challenges, and can significantly impact the physical and mental
well-being of people. Long-term stress can aggravate depressive and anxious symptoms, and in
certain situations, it can even cause psychiatric diseases to manifest (American Psychological
Association, 2022). Chronic stress is known to dysregulate the hypothalamic-pituitary-adrenal
(HPA) axis, leading to prolonged exposure to cortisol, a key stress hormone which had been linked
to the development of chronic illnesses like diabetes and cardiovascular disease, as well as immune
system impairment and inflammation McEwen and Akil, (2020). Long-term stress has also been
linked to metabolic syndrome, a group of disorders that increases the risk of type 2 diabetes, heart
disease, and stroke Epel et al., (2021). According to a study by Smith et al. (2023), there is a
significant correlation between stress and mental health because those who are under a lot of stress
are more prone to experience mood disorders. The negative consequences of stress on health are
lessened by self-regulation, which serves as an essential mediator in helping people effectively
manage their thoughts, emotions, and behaviors Fan and Cui, (2024). Despite the established
connection, our study fills numerous important gaps by offering a multifaceted, qualitative
2
investigation of the relationship between student stress and health. The study concurrently present
reviews of physical, psychological, immunological, and neuroendocrinological symptoms. It
captures lived experiences of stress-related health effects among students by using qualitative
methodologies. It provided and recommended culturally relevant intervention strategies unique to
the Nigerian cultural system. The study provides educational institutions with useful advice on
how to create supportive services that work. Health psychology, education, and public health can
all benefit from it as it enhances theoretical knowledge as well as real-world applications. This
study provides multidimensional perspectives and qualitative methods of analysis of the stress-
health relationship among students. It advances both theoretical understanding and practical
applications, making it a valuable contribution to the fields of health psychology, education, and
public health.
Objectives are to:
i. to explore theoretical foundations of stress and health
ii. to explore the impact of stress on health
iii. to identify specific case studies and the nature of stress experience in each case
iv. determine the subjective interpretation of the impact of stress on health for each of the cases
and suggest potential pathways of interaction.
v. Suggest culturally relevant intervention suitable for the Nigeria setting.
Theoretical Foundations of Stress and Health
Hans Selye in the 1930s introduced the General Adaptation Syndrome (GAS) (1936).
Endocrinologist Hans Selye (1956) identified a range of non-specific stimulus events (such as heat,
cold, and poisonous chemicals) during a series of animal investigations. He referred to these as
stressors because they produced a response pattern, he named the "General Adaptation Syndrome"
(GAS). According to Selye, the GAS develops in three phases. Hans Selye first postulated the
General Adaptation Syndrome (GAS) in 1936. The three stages of GAS depict the body's
physiological response to stress: Alarm Stage: This initial stress response sets off the sympathetic
nervous system, which releases stress hormones including cortisol and adrenaline. Thanks to this
"fight-or-flight" response, the body prepares to either confront or escape the stressor. Resistance
occurs when the stress doesn't go away. The body experiences resistance as it tries to cope with
the stressor due to high hormone levels which may persist despite effort, leading to the adjustment
of physiological functions in trying to counteract the stressor's effects. Stage of Exhaustion:
Prolonged stress depletes the body's resources, weakening defenses against illness and increasing
vulnerability. Selye (1974, 1983, 1993) revised the GAS to account for the possibility that,
although stress may cause substantial damage to the biological system, its absence may equally be
detrimental.
The Transactional Model of Stress and Coping (TMSC: Lazarus and Folkman, 1984)
Transactional models of stress and coping (TMSC: Lazarus and Folkman, 1984) and its revision,
the Cognitive Motivational Relational Theory (CMRT: Lazarus, 1991a, 1999, 2000), suggest that
a multitude of factors impact the outcome of a stressful encounter. The TMSC has undergone
further development and refinement since it was first presented by Lazarus and Folkman in their
book "Stress, appraisal, and coping" (Lazarus and Folkman, 1984). In primary assessment, an
3
individual determines whether something presents a risk, danger, or difficulty. This preliminary
evaluation determines the sort and intensity of the stress reaction. In secondary appraisal, options
and resources to address the stressor are evaluated. Although inadequate coping strategies can
exacerbate stress and lead to health problems, efficient coping strategies can mitigate the adverse
effects of stress. Two types of coping strategies include problem-focused coping, which involves
solving the stress-causing issue and emotion-focused coping, which involves managing emotional
responses to stress. The effectiveness of these coping mechanisms has a significant impact on the
impact of stress on health.
Allostatic Load Theory (Bruce McEwen)
According to Fava, McEwen, Guidi, Gostoli, Offidani, and Sonino (2019), allostatic overload
occurs when environmental difficulties surpass an individual's capacity for adjustment. Many
factors can cause allostatic load or overload to develop, including (a) frequent exposure to stressors
that can cause chronic stress and recurrent physiological arousal; (b) a lack of adaptation to
stressors that occur repeatedly; (c) an inability to stop the stress response after a stressor is stopped;
and (d) an allostatic response that is insufficient to handle the stressor (McEwen 1998; McEwen
2008). Different physiological systems interact to differing degrees depending on the demands of
the environment McEwen, Stellar (1993). The immune and neuroendocrine systems react to
dangers and adversity from the outside and help people adapt to them. McEwen (1998); McEwen
(2007). Both nongenomic and genomic processes influence the structure of the brain and its
neurochemical processes Grey, Kogan, Marrocco, and McEwen (2017); McEwen, Bowles, Gray,
Hill, Hunter, Karatsoreos, et al. (2015). An important part of the pathophysiology of allostatic
stress is the hypothalamic-pituitary-adrenal axis McEwen, (2007) and Chrousos, (2009). The
hypothalamic-pituitary-adrenal (HPA) axis mediates the stress response, which results in the
release of stress hormones like cortisol from the body. The HPA axis is activated by the
hypothalamus secretion of corticotropin-releasing hormone (CRH) during stressful situations. An
increased risk of chronic illnesses, metabolic problems, and immune system effects can result from
persistent stimulation of the HPA axis. The Sympathetic-Adrenal-Medullary (SAM) System
Activation is essential for the body's reaction to stress because it releases noradrenaline and
adrenaline.
Biopsychosocial Model (George Engel, 1977)
George Engel's biopsychosocial model, which integrated biological, psychological, and social
factors in understanding health and illness. This holistic approach highlighted the
interconnectedness of various stress-related factors. It should be noted that while the GAS theory
explains the general pattern of the stress response, the particular response and duration of each
stage can vary depending on the individual and the nature of the stressor. This model considers the
biological, psychological, and social factors that impact stress and suggests that stress involves an
interaction between these three dimensions and that the individual's response to stress is influenced
by their genetics, personality, and social support.
Stress and Cardiovascular Health
According to research, persons who experience high levels of stress are more likely to experience
an acute cardiac event Rosengren, Hawken, Ounpu, Zubaid, Akmahemeed, and Silwa (2004).
When compared to previous studies conducted in Nigeria and Africa, the prevalence of CV risk
factors was higher in the study conducted by Akintunde, Salawu, and Opadijo (2014). Findings
4
from Hendricks, Quinn, Price, et al, (2023) suggest that first responders with a ‘stress-is-negative
mindset’ have significantly higher general stress levels and that a negative stress mindset was a
statistically significant predictor of cardiovascular risk factors. A study including ten countries
discovered a 40%–60% correlation between chronic stress and congenital heart abnormalities, with
individuals experiencing three or more childhood challenges at a higher risk of developing the
condition Angermeyer, Scott, Von Korff, and others (2011). There is reportedly an increased risk
of hypertension, hyperlipidemia, obesity, and cardiovascular disease in patients with post-
traumatic stress disorder Coughlin, (2011). The Stockholm female coronary risk study reports
marital stress worsens the disease prognosis in females with CHD Orth-Gomér, Wamala, Horsten,
Schenck-Gustafsson, Schneiderman, Mittleman, (2000). According to Coughlin (2011),
individuals with post-traumatic stress disorder may be more susceptible to hypertension,
hyperlipidemia, obesity, and cardiovascular disease.
The Immune System's Reaction to Stress
Long-term immunosuppressive effects can result from immune system adjustments (leukocytes,
cytokines, inflammation, etc). Chronic stress has been linked to a general immunosuppressive
effect, which inhibits or prevents the body from mounting an effective, timely immune response,
according to many studies Huebner (1992); Hafen, Frandsen, Karren, and Hooker (1991).
Segerstrom and Miller's (2004) analyses demonstrated that the most persistent stressors—those
that alter people's identities or social roles, are more beyond their control, and appear endless—
were linked to the highest levels of global immunity expression, with nearly all immune function
measures declining. Research on the relationship between stress and the advancement of the
acquired immunodeficiency syndrome (AIDS) in patients has yielded inconsistent findings
Solomon, Kemeny, Temoshok, (1991). Researchers have found a significant relationship between
immunological parameters reflective of HIV progression and psychosocial factors, particularly
denial and distress Ironson, Friedman, Klimas, et al. (1994) and concealment of homosexual
identity.
Stress and the Digestive System
Stress has been shown to either cause or worsen gastrointestinal diseases, including peptic ulcers,
GERD, and irritable bowel syndrome (IBS). According to Drossman, Sandler, and McKee (1982),
abuse throughout early childhood increases a person's risk of developing both FGD and IBD later
in life. Studies on individuals with gastric fistulas have demonstrated that while depression and
withdrawal reduce stomach acidity, anger and hostility enhance it, which in turn causes ulcers.
When there is no barrier to protect the tissue, hydrochloric acid can penetrate blood vessels and
break down tissue, leading to bleeding ulcers Greenberg (2002).
Stress and Mental Health
Chronic stress can have a detrimental effect on mental functions like concentration, memory, and
decision-making. This is partly due to the negative effects of cortisol on the hippocampus, a region
of the brain that is important for learning and memory. There is a high correlation between stress
and neuroses, Castine, Meaador-Woodruff, Dalack, (1998); Chung, Langeluddecke, Tennant,
(1986); Norman, Malla, (1993); Cooper and Sylph (1973); Mckeon, Roa, and Mann (1984);
Rajendran, Rao and Reddy (1996). According to Norman and Malla, (1993), people with
schizophrenia reported higher levels of subjective stress while not experiencing more stressful life
events than normal controls. Acoba (2024) investigated the mediating function of perceived stress
in the association between the pandemic's effects on mental health outcomes in a study and founds
5
that social support from close friends and family members considerably lowers perceived stress,
which in turn enhances positive affect and lowers anxiety and depression Acoba, (2024). The
systematic study by Salari, Khazaie, Hosseinian-Far, et al. (2020) emphasized the need for focused
interventions by highlighting the significant mental health burden placed on frontline workers
working under stressful conditions Yaribeygi, Johnston, Sahebkar, Panahi, and Sahraei, (2017).
Stress and Cancer
Tumor growth appears to be promoted by both acute and chronic stress, including surgery and
social upheavals. Sorting out the impact of stress is further complicated by the interconnections of
numerous systems, including the immune system, endocrine system, and environmental elements
that are beyond our control and cause cancer. Furthermore, unlike animals, individuals cannot be
exposed to tumor cells by researchers. Azar (1999) discovered in a recent study that there was a
connection between natural killer (NK) cells, a subset of white blood cells, and tumor formation
under stress. According to a study, social support and stress have a significant impact on a man's
risk of prostate cancer Stone, Mezzacappa, Donatone, and Gonder, (1999).
Stress and Asthma
Both internal and external elements contribute to asthma; however, the impact of psychological
stressors on the body's surface mostly affects the internal factors. Furthermore, asthmatics believed
to be allergic would experience a severe attack when exposed to a harmless material Elliott,
Eisdorfer, (1982). Several of the Minnesota Multiphasic Personality Inventory (MMPI) distressed-
related measures showed strong positive relationships with skin reaction to allergens, according to
a 1993 study by Gauci et al. When taken as a whole, these data show a strong correlation between
immunological dysfunction, stress, and the clinical manifestations of asthma and atopic diseases.
Stress and Migraine headaches
Migraine is linked to feelings of uneasiness, rage, anxiety, or suppressed fury. When someone lets
out their innermost feelings, it could stop an attack Pelletier (1977). Additionally, studies by
Stenstrom, Wikby, Hornquist, and Andersson (1993) have shown a correlation between
emotionally taxing experiences and endocrine disorders such as diabetes mellitus.
Stress and Diabetes
Psychological or physical stressors can change the amount of insulin required; stressors are
frequently the cause of episodes of losing control, particularly in children with diabetes. Type II
diabetes is most commonly influenced by stress because it usually affects overweight adults and
is a milder form of the disease Elliott and Eisdorfer, (1982). Children who experienced stressful
life events between the ages of 5 and 9 that resulted in real or threatened losses in the family had
a significantly higher risk of developing type I diabetes.
Stress and Hepatitis
The T-cell and virus-specific antibody responses to hepatitis B can be inhibited by acute stress
Glaser, Sheridan, Kiecolt-Glaser, and Malarkey (1998). Individuals who do not respond well to
vaccinations are more likely to get sick, including from influenza. Additional research has shown
a connection between psychological stress and vulnerability to various cold viruses Cohen, Doyle,
Cohen, Frank, Rabin, and Gwaltney (1998); Cohen, Tyrrell, and Smith (1991). Not surprisingly,
stress weakens the immune system, which makes it easier for latent viruses to resurface since the
body is unable to fight them off.
6
Multiple Pathways Linking Stress to Health
Neuroendocrine Pathway: Activation of the hypothalamic-pituitary-adrenal (HPA) axis leads to
the release of cortisol and other stress hormones. Chronic cortisol exposure can impair immune
function, increase blood pressure, alter glucose metabolism, and contribute to mental health
disorders like anxiety and depression.
Inflammatory Pathway: Stress-induced activation of the immune system leads to the release of
pro-inflammatory cytokines. Chronic inflammation is linked to numerous health conditions,
including cardiovascular diseases, diabetes, autoimmune disorders, and mental health issues.
Behavioral Pathway: Stress influences behaviors such as diet, physical activity, substance use, and
sleep patterns. Unhealthy behaviors resulting from stress can lead to obesity, cardiovascular
diseases, metabolic syndrome, and poor mental health.
Suggested Culturally Relevant Interventions for Nigerian
Mindfulness and Meditation: This involves the use of culturally appropriate interventions, such
as mindfulness training in the community and conventional therapeutic techniques that incorporate
cultural activities such as music (‘esa, ijala ewi’), storytelling (‘Alo’), local proverbs(‘owe’) and
family lineage oration (‘oriki idile”). Showcasing well-known Nigerian artists who are engaged in
local mindfulness techniques and emphasizing the advantages of quiet, introspective activities
when working together with traditional healers to reduce stress.
Professional Help and Counseling: This involves encouraging the use of counseling and other
professional assistance in Nigeria by sharing testimonies, collaborating with experts to provide
services that are sensitive to cultural differences, and utilizing content that is appropriate for the
local context. Addressing financial difficulties by providing microfinance and financial literacy
workshops.
Cultural Sensitivity in Stress Management: The significance of incorporating Nigerian cultural,
religious, and customary practices into stress management programs is emphasized throughout this
suggestion. It emphasizes the value of religion in Nigerian culture by highlighting
accomplishments, public awareness efforts, and spiritual support from religious leaders.
Physical Activity and Diet: In line with cultural values, this encourages sports and leisure pursuits
that foster social contact and physical exercise. It emphasizes football, sports, and traditional
Nigerian recreational activities such as dances (‘bata’), traditional games (‘Ayo, Foli’) as ways to
relieve stress. Along with sharing the success stories (‘itan’) of Nigerian athletes, it also
emphasized the value of getting enough sleep and maintaining a good diet. Creating neighborhood
groups to offer prompt assistance in times of need.
Social Support and Connection: This emphasized the value of developing close relationships
within the community and the family, encouraging support from friends, family, and community
leaders, and developing initiatives to get families involved in social activities as a stress-reduction
strategy.
Time Management and Organization: Teaching time management techniques to Nigerians
students through the use of culturally appropriate examples, easily accessible materials, and the
7
presentation of effective time management case studies that emphasize the advantages of these
abilities.
Research Methodology
Study Design
Multiple case study methodology was adopted to explore the stress-health relationship among 5
students from a private a university in Nigeria. This approach allows for a deep understanding of
individual experiences and contextual factors.
Case-file Selection
Sampling Method: Purposive sampling was adopted to select case files of 5 students who met the
criteria for inclusion. The students were mostly sent for one-on-one counseling to see a
psychologist in the Department of Psychology by the student disciplinary committee. The
inclusion criteria are that students whose case files would be selected must have completed their
counseling/intervention sessions in the department based on a referral from the committee
Data Collection
Question: “Can you describe how your body and mind react when you are under a lot of
pressure or stress?"
We review five anonymized records of students from counseling sessions to extract their responses
to this specific question: “Can you describe how your body and mind react when you are under a
lot of pressure or stress?" This question is broad and open-ended, encouraging the respondent to
discuss various aspects of their stress response. Here's how it can uncover information on different
themes: Physical Symptoms: The respondent might mention physical reactions such as headaches,
muscle tension, or stomach issues. Psychological Symptoms: They may describe feelings of
anxiety, being overwhelmed, or difficulty concentrating. Immunological Symptoms: The
respondent might talk about getting sick more often or feeling run down. Neuroendocrinological
Symptoms: They could mention sleep disturbances, changes in appetite, or feelings of fatigue.
Result
Students’ responses to the Question
Student A
Reaction: "My body has suffered from stress." I frequently experience tense headaches and aches
in my muscles. I've found that I get colds more frequently, and I believe that stress weakens my
immune system. I get a lot of anxiety and depressive episodes in my mind. In addition, my irregular
sleep patterns and constant tiredness despite getting plenty of sleep lead me to believe that stress
has disrupted my hormonal equilibrium."
Student B
Reaction: "I get really bad stomachaches and migraines when I'm stressed out. I appear to get sick
with every common cold and flu, which suggests that my immune system is compromised. I
struggle to maintain motivation because I feel anxious and overburdened psychologically. I believe
that stress also affects my hormones because I have problems falling asleep and frequently wake
up feeling exhausted even after getting a full night's rest."
8
Student C
Reaction: "I have frequent headaches and stomach problems like nausea and indigestion when I'm
stressed out. I also note that, during stressful times, I tend to become sick more frequently, which
I attribute to a reduced immune system. My psychological state of anxiety and occasional
depression makes it difficult for me to concentrate. My tendency to feel tense and find it difficult
to unwind, even when I'm trying to sleep, suggests that my stress levels are impacted by my cortisol
levels.
Student D
Reaction: "Physically, stress makes me tired and gives me migraines. Because I get sick more
frequently when I'm stressed, I also see that my immune system isn't as powerful. I experience
anxiety in my mind and occasionally panic attacks. I believe that stress has an impact on my
hormones because I frequently feel tired even after trying to relax and have erratic sleep patterns."
Student E
Reaction: "My physical health is significantly impacted by stress. In addition to having frequent
headaches, I occasionally become sick. I seem to have a weakened immune system because I get
colds readily when I'm under stress. I get mental anxiety and frequently find it difficult to focus. I
believe that stress has an impact on my hormone balance because it causes me to have very erratic
sleep patterns and leaves me feeling exhausted no matter how much sleep I receive."
Data Analysis
Cross-Case Analysis
Content and narrative analysis were adopted to summarize the data from each case file. We
compare and contrast the 5 case studies to identify commonalities and differences in stressors,
health impacts, potential pathways, and interventions. We classify each case according to the
identified pathways of interaction (psychological, physiological, immunological, neurological, and
physical). We identify patterns in how different stressors impact health and the effectiveness of
various coping strategies.
Thematic Analysis:
We started by familiarizing ourselves with the Data. We read, reread, and summarized the
responses provided by student A-E to establish familiarity with the data. We identified key phrases
or ideas within each response that represent common themes related to stress and health outcomes
and coded it as physical symptoms, psychological distress, immune system responses, and
neuroendocrinological effects. We then search for the themes by grouping similar codes to identify
overarching themes that emerge across the responses of student A-E. Patterns and connections
between different themes of the data were identified to gain a deeper understanding. The identified
themes were reviewed to ensure they accurately reflect the data and capture the essence of students'
experiences with stress and health outcomes. Each theme is defined with clear descriptions and
examples from the responses.
Narrative Analysis:
We examine the structure of each student's response, including the beginning, middle, and end.
Take note of the main narrative elements such as the sequence of events, onset, peak, symptoms,
examine the history of the student narrating the experience, and the setting to understand how
students construct their stories about stress and health. The content of each narrative was analyzed
9
to identify recurring themes and patterns related to stress and health outcomes. Noting how
students describe their experiences, emotions, and coping strategies within the narrative
framework. The narratives of student A-E were compared to identify commonalities and
differences in their experiences with stress and health. Taking note of unique insights and
perspectives that emerge from each narrative, as well as shared themes across multiple narratives.
The findings from both thematic and narrative analyses were compared to make conclusions on
the overall impact of stress on health outcomes among students.
Physical symptoms for Student A-E
A-Physical Health: Experiences tension headaches and muscle aches, indicating physical
manifestations of stress.
B-Physical Health: Reports migraines and stomach pains as physical symptoms of stress.
C-Physical Health: Experiences headaches and stomach issues, indicating physical manifestations
of stress.
D-Physical Health: Reports migraines and sleep disruptions, indicating physical symptoms of
stress.
E- Physical Health: Experiences headaches and nausea, indicating physical manifestations of
stress.
Immune response for Student A-E
A-Immune Responses: Reports increased susceptibility to colds, suggesting a weakened immune
system during stressful periods.
B-Immune Responses: Indicates frequent illnesses during stressful periods, suggesting immune
system impairment.
C- Immune Responses: Notes increased susceptibility to illnesses, suggesting compromised
immune function during stress.
D- Immune Responses: Mentions increased susceptibility to illnesses, suggesting immune system
impairment during stress.
E- Immune Responses: Reports susceptibility to colds, suggesting compromised immune function
during stress.
Psychological Response for Student A-E
A-Psychological Response: Describes feelings of anxiety and doubt, highlighting the
psychological toll of stress.
B- Psychological Response: Describes feelings of being overwhelmed and anxious, affecting
mental health.
C- Psychological Response: Reports feelings of anxiety and loneliness, affecting mental health.
D- Psychological Response: Describes feelings of anxiety and panic attacks, affecting mental
health.
10
E- Psychological Response: Describes feelings of anxiety and difficulty concentrating, affecting
mental health.
Neuroendocrinological Effects for Student A-E
A-Neuroendocrinological Effects: Mentions disrupted sleep patterns and persistent fatigue,
indicating potential hormonal imbalances due to stress.
B- Neuroendocrinological Effects: Mentions trouble sleeping and fatigue, potentially linked to
disrupted hormonal balance.
C- Neuroendocrinological Effects: Describes disrupted sleep and heightened anxiety, indicating
potential hormonal effects of stress
D- Neuroendocrinological Effects: Notes irregular sleep patterns and persistent fatigue, potentially
linked to hormonal imbalances due to stress.
E- Neuroendocrinological Effects: Mentions disrupted sleep and fatigue, potentially linked to
hormonal imbalances due to stress.
Theme 1: Thematic and narrative Analysis of Physical Symptoms
Thematic Analysis: Physical symptoms such as headaches, muscle tension, and stomach issues are
identified as common themes across the responses of students A-E.
Narrative Analysis: Students describe experiencing physical discomfort and pain during stressful
periods, with symptoms varying in intensity and duration.
Theme 2: Thematic and narrative Analysis of Psychological Symptoms
Thematic Analysis: Psychological distress, including anxiety, feelings of being overwhelmed, and
difficulty concentrating, emerges as a key theme among students AE.
Narrative Analysis: Students express emotions of anxiety, doubt, and loneliness, highlighting the
psychological toll of stress on their mental wellbeing.
Theme 3: Thematic and narrative Analysis of Immune System Responses
Thematic Analysis: Many students report increased susceptibility to illnesses during stressful
periods, suggesting immune system impairment as a theme.
Narrative Analysis: Students describe experiencing frequent colds and illnesses, indicating
compromised immune function as a result of stress.
Theme 4: Thematic and narrative Analysis of Neuroendocrinological Effects
Thematic Analysis: Disrupted sleep patterns, fatigue, and hormonal imbalances are identified as
neuroendocrinological effects of stress among students AE.
Narrative Analysis: Students mention irregular sleep, persistent fatigue, and hormonal
disturbances, indicating the physiological impact of stress on their bodies.
11
Discussion of findings
All five students reported significant impacts of stress on their overall health, indicating that stress
is a common issue among students. Students frequently experienced physical symptoms such as
headaches, stomach issues, muscle tension, and sleep disturbances. This suggests a strong
connection between stress and physiological health problems. Students reported increased
susceptibility to colds and illnesses during stressful periods, highlighting how stress can weaken
the immune system. Anxiety and feelings of being overwhelmed were common among all
students, pointing to the psychological toll of academic and personal stressors. Some students also
reported symptoms of depression and burnout. The disruption of sleep patterns and persistent
fatigue mentioned by the students suggest that stress causes hormonal imbalance and affects the
neuroendocrine system, likely through elevated cortisol levels and other stress hormones. This
study suggested the implementation of a culturally relevant intervention strategies. This study is
in line with the study by Deng, Cherian, Khan, Kumari, Sial, Comite, Gavurova Popp, (2022)
conclusion that extended academic stress positively impacts students' depression levels. Also,
Wang et al. Wang, Wen, Zhang, Ni, Jiang, Cheng, et al., (2021) study concluded that higher level
of academic stress is linked to a larger level of burnout, which leads to a higher degree of
depression. Increased distress was associated with statistically significant increases in the
proportion of immune cell (B cells), regardless of trial arm. In a study of psychological distress by
Turner, Galante, Vainre, Stochl, Dufour and Jones, (2020). Students experience high stress levels
in their final educational years, which might increase the risk of health issues and low academic
performance Al-Rouq, Al-Otaibi, AlSaikhan, Al-Essa, Al-Mazidi.
The significance of the study
The study adds to the body of knowledge on how stress affects students' health by providing
qualitative insights into the complex interconnected pathways of physiological, immunological,
psychological, and neuroendocrinological effects. The study demonstrates the value of qualitative
research in understanding the subjective experiences of stress, providing rich, detailed data that
quantitative methods might overlook. By examining multiple pathways of stress effects, the study
offers a holistic perspective that can inspire future research to adopt similarly comprehensive
approaches. The findings can guide educational institutions in designing and implementing
effective and culturally relevant mental health services and support systems tailored to the specific
needs of students. The study brings attention to the widespread issue of student stress and its
diverse impacts, fostering greater awareness among educators, parents, and policymakers about
the importance of mental health in educational settings. The results can inform policy changes at
institutional and governmental levels, advocating for more resources and support systems
dedicated to student mental health.
Conclusion
These qualitative insights provide valuable context for understanding the complex relationship
between stress and health outcomes among students, emphasizing the need for comprehensive
support and intervention strategies to address these issues effectively. The analysis reveals that
stress has a multidimensional impact on students, affecting various aspects of their health including
physical, psychological, immune, and neuroendocrinological domains. While common themes
emerge across the responses of student A-E, there are also individual differences in how students
experience and respond to stress. This explains the need for culturally relevant intervention to be
incorporated by policymakers and healthcare experts to improve the well-being of Nigerian
students.
12
Recommendations
Schools should incorporate a culturally relevant mental health intervention to help students
manage stress effectively. Recognizing the fact that each student’s experience with stress is unique,
so as to provide personalized support tailored to individual needs.
Implications for Healthcare Providers and Policymakers
The study promotes holistic health approaches that take cultural, emotional, and physical factors
into account. It places a strong emphasis on educating medical professionals and psychologist
about ethnic cultures and stress beliefs, utilizing community leaders and traditional healers, and
incorporating therapies that are suited for the local culture.
Future Research and Implications
For a thorough knowledge of the links between stress and health, future research should combine
qualitative and quantitative analysis and concentrate on long-term studies to monitor the impacts
of stress on health and test the effectiveness of culturally relevant therapies suggested in this study
among varied Nigerian populations.
Contribution to knowledge
This study, which focuses on Nigerian students. The study emphasizes the intricate relationship
that exists between stress and physical, mental health, emphasizing the necessity for culturally
focused interventions. The findings advocate for comprehensive support systems including peer
support networks and mental health literacy programs, and the results have consequences for
educational policies and mental health practices.
References
Acoba, E. F. (2024). Social support and mental health: the mediating role of perceived stress.
Frontiers in Psychology. Retrieved from [Frontiers in Psychology]
(https://www.frontiersin.org/articles/10.3389/fpsyg.2024.1330720/full)
Akintunde, A.A., Salawu, A.A. and Opadijo, O.G. (2014). Prevalence of Traditional
Cardiovascular Risk Factors among Staff of Ladoke Akintola University of Technology,
Ogbomoso, Nigeria. Nigerian Journal of Clinical Practice, 17, 750-755.
https://doi.org/10.4103/1119-3077.144390
Al-Rouq F, Al-Otaibi A, AlSaikhan A, Al-Essa M, Al-Mazidi S. (2022). Assessing Physiological
and Psychological Factors Contributing to Stress among Medical Students:
Implications for Health. Int J Environ Res Public Health. Dec 15;19(24):16822.
doi: 10.3390/ijerph192416822. PMID: 36554703; PMCID: PMC9779130
American Psychological Association. (2022). Stress and mental health. Retrieved from
https://www.apa.org/topics/stress/mental-health
Azar B. (1993). Probing links between stress and cancer. APA Monitor Online. 1999; 30:1–4.
http://www.apa.org/monitor/jun99/stress.html) [Google Scholar]
13
Castine MR, Meaador-Woodruff JH, Dalack WH. (1998). The role of life events in the onset and
recurrent episodes of schizophrenia and schizoaffective disorders. J Psychiat Res.;
32:283–288. [PubMed] [Google Scholar]
Chung RK, Langeluddecke P, Tennant C. Threatening life events in the onset of schizophrenia,
schizophreniform psychosis and hypomania. Brit J Psychiat. 1986; 148:680–685.
[PubMed] [Google Scholar]
Cohen S, Frank E, Doyle WJ, Skoner DP, Rabin S, Gwaltney JM., Jr. (1998). Type of stressors
that increase susceptibility to the common cold in adults. Health Psychol.; 17:214–223.
[PubMed] [Google Scholar]
Cohen S, Tyrrell DAJ, Smith AP. (1991). Psychological stress in humans and susceptibility to the
common cold. New Engl J Med; 325:606–612. [PubMed] [Google Scholar]
Cooper B, Sylph J. (1973). Life events and onset of neurotic illness. An investigation in general
practice. Psychol Med; 3:421–435. [PubMed] [Google Scholar]
Coughlin SS (2011). Post-traumatic stress disorder and cardiovascular disease. Open Cardiovasc
Med J. 2011; 5:164–170. [PMC free article] [PubMed] [Google Scholar]
Deng Y, Cherian J, Khan NUN, Kumari K, Sial MS, Comite U, Gavurova B, Popp J. (2022).
Family and Academic Stress and Their Impact on Students' Depression Level and
Academic Performance. Front Psychiatry. Jun 16; 13:869337.
Drossman DA, Sandler RS, Mckee DC. (1982). Bowel patterns among subjects seeking
treatment. Health Care. 83:529–34. [PubMed] [Google Scholar]
Elliott GR, Eisdorfer C. (1982). Stress and Human Health. New York: Springer Publishing
Company; [Google Scholar]
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science,
196(4286), 129–136.
Epel, E. S., et al. (2021). Stress and metabolic syndrome. Annual Review of Medicine, 72, 95-110.
doi:10.1146/annurev-med-042320-091847
Fan. L and Feng Cui F (2024). Mindfulness, self-efficacy, and self-regulation as predictors of
psychological well-being in EFL learners, Front. Psychol., 27 March 2024, Sec.
Personality and Social Psychology, Volume 15 - 2024
Fava GA, McEwen BS, Guidi J, Gostoli S, Offidani E, Sonino N. (2019). Clinical
characterization of allostaticoverload. Psychoneuroendocrinology. 2019 Oct; 108:94–
101.Google ScholarCrossref PubMed
Furnham, A. (1997). The psychology of behaviour at work: The individual in the organization
Hove, England UK: Taylor and Francis.
14
Gauci M, King MG, Saxarra H, Tulloch BJ, Husband AJ. (1993). A Minnesota Multiphasic
Personality Inventory of woman with allergic rhinitis. Psychol Med. 1993; 55:533–40.
[PubMed] [Google Scholar]
Glaser R, Kiecolt-Glaser JK, Malarkey WB, Sheridan JF. (1998). The influence of psychological
stress on the immune system to vaccines. Ann NY Acad Sci. 840:649–655. [PubMed]
[Google Scholar]
.McEwen BS. (1998). Stress, adaptation, and disease. Allostasis and allostatic load. Ann N Y
Acad Sci. May;840(1):33–44. 1998.tb09546.x[PubMed]0077-8923
Gray JD, Kogan JF, Marrocco J, McEwen BS. (2017). Genomic and epigenomic mechanisms of
glucocorticoids in the brain. Nat Rev Endocrinol. 2017Nov;13(11):661–73.
https://doi.org/10.1038/nrendo.2017.97[PubMed]1759-5029 Google ScholarCrossref
PubMed
Greenberg JS. (2002). Comprehensive stress management. 7th ed. New York: McGraw-Hill.
[Google Scholar]
Hafen BQ, Frandsen KJ, Karren K, Hooker KR. (1991). The health effects of attitudes, emotions
and relationship. Provo UT: EMS Associates; [Google Scholar]
Hendricks, B., Quinn, T.D., Price, B.S. et al. (2023). Impact of stress and stress mindset on
prevalence of cardiovascular disease risk factors among first responders. BMC Public
Health 23, 1929, https://doi.org/10.1186/s12889-023-16819-w
Huebner HS. (1992). Burnout among school psychologists: An exploratory investigation into its
nature, extent and correlates. School Psychol Quart; 7:129–36. [Google Scholar]
Ironson G, Friedman A, Klimas N, et al. (1994). Distress and low adherence to behavioural
interventions predict faster disease progression in gay men infected with human
immunodeficiency virus. Int J Behav Med. 1994; 1:90–105. [PubMed] [Google Scholar]
Lazarus RS. Stress and emotion: A new synthesis. New York, NY, USA: Springer; 1999.
Lazarus, R. S. (1991a). Progress on a cognitive-motivational-relational theory of emotion.
American Psychologist, 46, 819-834.
Lazarus, R. S. (1999). Stress and emotion: A new synthesis. New York: Springer.
Lazarus, R. S. (2000). Cognitive-motivational-relational theory of emotion. In Y. L. Hanin (Ed.),
Emotions in sport (pp. 39–63). Champaign, IL: Human Kinetics.
Lazarus, R. S. (2000). Cognitive-motivational-relational theory of emotion. In Y. L. Hanin (Ed.),
Emotions in sport (pp. 39–63). Champaign, IL: Human Kinetics.
Lazarus, R., and Folkman, S. (1984). Stress, appraisal and coping. New York: Springer.
15
McEwen BS, Bowles NP, Gray JD, Hill MN, Hunter RG, Karatsoreos IN, et al. (2015).
Mechanisms of stress in the brain. Nat Neurosci. 2015Oct;18(10):1353–63.
https://doi.org/10.1038/nn.4086 [PubMed]1097-6256 Google ScholarCrossref PubMed
McEwen BS, Stellar E. (1993). Stress and the individual. Mechanisms leading to disease. Arch
Intern Med. Sep;153(18): 2093101. https://doi.org/10.1001/archinte. 00410180039004
McEwen BS. (2008). Central effects of stress hormones in health and disease: understanding the
protective and damaging effects of stress and stress mediators. Eur J Pharmacol.
2008Apr;583(2-3):174–85. [PubMed]0014-2999
McEwen BS. (2007). Physiology and neurobiology of stress and adaptation: central role of the
brain Physiol Rev. Jul;87(3):873–904, https://doi.org/10.1152/physrev.00041.2006
[PubMed]0031-9333, Google ScholarCrossref PubMedMcEwen, 2007;
McEwen, B. S., & Akil, H. (2020). Stress and the individual: Mechanisms leading to disease. Cell,
183(1), 11-34. doi: 10.1016/j.cell.2020.09.021
Mckeon J, Roa B, Mann A. (1984). Life events and personality traits in obsessive-compulsive
neurosis. Brit J of Psychiat; 144:185–189. [PubMed] [Google Scholar]
Norman RMG, Malla AK. (1993). Stressful life events and schizophrenia: A review. Brit J
Psychiat; 162:161–166. [PubMed] [Google Scholar]
Orth-Gomér K, Wamala SP, Horsten M, Schenck-Gustafsson K, Schneiderman N, Mittleman MA.
(2000). Marital stress worsens prognosis in women with coronary heart disease. The
Stockholm Female Coronary Risk Study. JAMA. 2000; 284:3008–3014. [PubMed]
[Google Scholar]
Pelletier KR. (1977). Mind as healer, mind as slayer. New York: Dell Publishing Co.
[Google Scholar]
Rajendran K, Rao VN, Reddy MV. (1996). A profile of stressful life events among industrial
neurotics and normal. NIMHANS Journal.14:127–132. [Google Scholar]
Salari, N., Khazaie, H., Hosseinian-Far, A. et al. (2020). The prevalence of stress, anxiety and
depression within front-line healthcare workers caring for COVID-19 patients: a
systematic review and meta-regression. Hum Resour Health 18, 100 (2020).020-00544-1
Salleh M. R. (2008). Life event, stress and illness. Malays J Med Sci. Oct;15(4):9-18. PMID:
22589633; PMCID: PMC3341916.
Scott KM, Von Korff M, Angermeyer MC, et al. (2011). Association of childhood adversities and
early-onset mental disorders with adult-onset chronic physical conditions. Arch Gen
Psychiatry. 2011; 68:838–844. [PMC free article] [PubMed] [Google Scholar]
Segerstrom SC, Miller GE. (2004). Psychological stress and the human immune system: A meta-
analytic study of 30 years of inquiry. Psychol Bull.130:601–30. [PMC free article]
[PubMed] [Google Scholar]
16
Selye, H. (1956). The Stress of Life. Toronto: McGraw-Hill.
Selye, H. (1974). Stress without distress. Philadelphia: Lippincott Co.
Selye, H. (1983). The stress concept: Past, present, and future. In C. L. Cooper (Ed.), Stress
research: Issues for the eighties (pp. 1–20). New York, NY: John Wiley and Sons.
Selye, H. (1993). History of stress concept. In L. Goldberger and S. Breznitz (Eds.), Handbook
of stress: Theoretical and clinical aspects (2nd ed.) (pp. 7-17). New York: The Free Press.
Selye, H., 1936. A syndrome produced by diverse nocuous agents. Nature 138, 32.
Selyes H. The stress of life. New York: Mc Graw Hill; 1956. [Google Scholar]
Smith, J. M., et al. (2023). Stress and mood disorders: A longitudinal study. Journal of Affective
Disorders, 310, 213-220. doi: 10.1016/j.jad.2022.12.012
Solomon GF, Kemeny ME, Temoshok LT. (1991). Psychoneuroimmunologic aspects of human
immunodeficiency virus infection. In: Ader R, Felten D, Cohen N, editors.
Psychoneuroimmunology. San Diego, California: Academic Press. pp. 1081–1114.
[Google Scholar]
Stenstrom U, Wikby A, Hornquist JO, Andersson PO. (1993.) Recent life events, gender and the
control of diabetes mellitus. Gen Hosp Psychiat.15:82–8. [PubMed] [Google Scholar]
Steptoe A, Kivimäki M. (2013). Stress and cardiovascular disease: an update on current
knowledge. Annu Rev Public Health. 2013; 34:337–354. [PubMed] [Google Scholar]
Stone AA, Mezzacappa ES, Donatone BA, Gonder M. (1999). Psychosocial stress and socia
upport are associated with prostate-specific antigen in men: Results from a community
screening program. Health Psychology.18:482–486. [PubMed] [Google Scholar]
Tsigos C, Kyrou I, Kassi E, et al. (2000). Stress: Endocrine Physiology and Pathophysiology
[Updated Oct 17]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext
[Internet]. South Dartmouth (MA): MDText.com, Inc.; -. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK278995/
Turner L, Galante J, Vainre M, Stochl J, Dufour G, Jones P.B. (2020). Immune dysregulation
among students exposed to exam stress and its mitigation by mindfulness training: findings from
an exploratory randomised trial. Sci Rep. Apr 2;10(1):5812. doi: 10.1038/s41598- 020-
62274-7. PMID: 32242145; PMCID: PMC7118166.
Wang C, Wen W, Zhang H, Ni J, Jiang J, Cheng Y, et al. (2021). Anxiety, depression, and stress
prevalence among college students during the COVID-19 pandemic: a systematic review
and meta-analysis. J Am Coll Health. 1−8. 10.1080/07448481.2021.1960849
[PubMed] [CrossRef] [Google Scholar]