The aim of this study was to determine the extent and causes (socio-economic factors, attitudes and knowledge) of self-medication among the students of the Health School of Mashhad University of Medical Sciences, Iran in 2022. The rate of self-medication was approximately between 20–25 that is relatively low compared to similar studies. In a meta-analysis conducted in 2020, the prevalence of self-medication among university students worldwide was 70.1% (7). Among health sciences students of Kermanshah University of Medical Sciences, the prevalence of self-medication was 89.6% in 2016(18). Moreover, the studies by Sawalha et al. and Klemenc_ketis et al. showed that self-medication is prevalent among university students(19, 20). Moreover, a study in Zabol showed that the prevalence of self-medication is higher among university students than other groups of population(21).
According to some studies, self-medication among students has been associated with age, being female, study field and year of study(22–24). In the University of Karachi in Pakistan, Shah et al. found that self-medication is a gender-neutral problem. In addition, the prevalence of self-medication was the same among married and single students (4, 18). Self-medication did not differ significantly in terms of variables such as age, insurance status and type of residence in another study(18). Among the reasons why the participants in the study self-medicate, more than half of them believed their medicine was safe, also stated that they knew their illness and did not need visit a physician. Similar to Abdi. et al, the study by Azami-Aghdash et al. showed that previous experience with similar drugs was the cause of self-medication (18, 25). The reason for the students of Iran University of Medical Sciences was having sufficient information about diseases and medications(26).
According to the present study, undergraduate students had the highest rate of self-medication compared to others, and PhD students had the lowest rate. Moreover, acetaminophen, analgesics, cold medicines, and multivitamins were the most commonly used medicines by health sciences students. In Kermanshah University of Medical University, pain killers and antibiotics were commonly taken without prescription of a physician (18). In Iran University of Medical Sciences, antitussives, cold medicines, analgesics, and antihistamines were commonly used for self-medication(26). Ansari et al. indicated that 10% of students use psychotropic drug arbitrary(27). Other studies showed that the most common drugs were paracetamol (28, 29), amoxicillin and metronidazole(4).
The most frequently form of drug used for self-medication was the pill and capsule, while, eye drops and suppositories were less used. The highest rate of self-medication was for headache, cold, anemia and gastrointestinal diseases. General causes of self-medication among students at the University of Rio Grande, Brazil were headache, cold, sore throat, fever, menstrual cramps, muscle aches, cough and heartburn, as well as stomach pain, nausea, vomiting, allergies and colic(30). In Karachi, the most common symptoms were headache, fever, and the flu which students self-medicated for(31). In Abbottabad, Pakistan, the most common diseases followed by self-medication were occasional pain, common infections, coughs, and colds (32). In the study by Mortazavi et al. in Iran, respiratory diseases, colds and headaches were the reasons for self-medication (33). The results of a study conducted in 2018 on the students of Zabol University of Medical Sciences showed that common cold was the disease often treated with self-medication; and antibiotics were the most used drugs (21).
Common diseases, the experience of recovery with self-medication, and mild and limited nature of some diseases may be motives for patients not to consult a physician (25, 34). Simplification of the diseases and their symptoms (35), and dissatisfaction with the health system were reasons for not visiting a physician(36). Some studies reported the lack of trust to physicians has been the reason for self-medication(35). Inadequate knowledge about the complications of self-medication and the communication gap between patients and the health care team might result in self-medication(18).
Studies showed that people believed that self-medication was cost-effective(36). In the present study, among those who stated that poor economic status was the cause of self-medication, more than half of them had health insurance. Studies in other developing countries have cited the lack of time to visit a physician and economic problems as the main reasons for self-medication (8, 14). The study of Shah et al. at the University of Karachi, Pakistan, showed that self-medication was higher among students who did not have health insurance, although the difference was not statistically significant (4). In another study, the students covered by health insurance received as much self-medication as students without health insurance, which may be related to the insurance companies’ programs as the insurer must pay a significant portion of the cost of the doctor's visit and medication (18). A study by Yousef et al. (2008) reported that self-medication was affected by high costs of health care (14), while the failure to enforce restrictive laws on the sale of antibiotics was a reason to continue self-medication(37). In Iran, as in many countries, dangerous and high-risk drugs must be sold with a prescription, and even the phrase "no-prescription" is labeled on medicine containers. However, this law is ignored by many pharmacies for various reasons such as insufficient supervision by the relevant authorities.
The high costs of physicians’ visit, and overcrowded health facilities have been reported as reasons for self-medication in the studies of Mortazavi et al. and Wen et al(33). Lack of access to health facilities has also been reported as a motive too(31). People self-medicated to save time and costs(35). The first source of information for self-medication that most participants referred to was a physician. This shows the role of physicians in preventing the overuse of drugs, especially antibiotics. In another study, the source was internet and the advice of pharmacists(18). They might be influenced by others’ advice such as family members and friends in practicing self-medication(33, 36).