Prevalence of stimulants among students of the Syrian Private University and its relationship with academic achievement and psychological state

doi:10.21203/rs.3.rs-4876823/v1

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Prevalence of stimulants among students of the Syrian Private University and its relationship with academic achievement and psychological state

https://doi.org/10.21203/rs.3.rs-4876823/v1

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Background: Non-medical use of neuropharmaceuticals generates significant discussions in medical and public health circles. The main motivation for this non-medical use of neuropharmaceuticals is to enhance cognitive function in healthy individuals beyond normal human capacity. Objective: The prevalence of stimulants among Syrian Private University students and its relationship with academic achievement and psychological status.

Methods: A cross-sectional study conducted at the Syrian Private University, during the period 12/1/2023 to 7/1/2024. The students' responses, numbering 386 male and female students, were studied through an electronically distributed questionnaire.

Results: The sample consisted of 386 students. With an average age of 22.40 years. The percentage of males was 51% compared to females 49%. The financial status was average at 40%. The students of the Faculty of Human Medicine constituted the largest number of students in the sample, reaching 45%. The most common reason for using these stimulants among the students who used them was staying up late and studying during exams and projects, which was 5% of the students. The fourth year was the highest year in terms of stimulant use among the students, with a rate of 4%. The students of the Faculty of Human Medicine were the students who had the highest anxiety score, which was 1.93 compared to the students of the other faculties.

Conclusion: The percentage of stimulant use among the students in our study was 8% of the total students. The most frequent motives for using stimulant drugs were reasons related to academic activities. The results of our study differed regarding the students' knowledge of stimulants and their side effects, as only 3% of the students in our study indicated their knowledge of these drugs and their side effects.

Psychology

Stimulants

Academic Achievement

Medical Students

Nootropics are defined as a group of medicinal substances that work to improve human thinking, learning, and memory. Although these substances are most effective in cases where cognitive functions are weak, they are of interest to healthy individuals because of their ability to increase intelligence and improve memory. Most of these substances are of natural origin and can be obtained without a prescription in the form of nutritional supplements or herbal extracts, and they tend to be well tolerated in patients with impaired cognitive functions. [1–3]

Students go through varying periods during their studies between psychological and physical pressures, especially during the exam period, which causes a lot of insomnia and anxiety. Therefore, we find that many university students rely on studying and studying late, which requires the use of stimulant medications, herbs, and mental stimulants because they believe that they contribute to increasing their ability to study continuously for several hours and obtain high grades in exams. However, some students find that the use of stimulants is only a psychological state, the goal of which is not to obtain high grades as much as it is a means of pressure on the body to remain active for a longer period, and after this period, the repeated use of these stimulants for long periods results in addiction to them. [4, 5]

Mental stimulants may cause the risk of dependence and addiction, as when using modafinil or caffeine drinks for a long time to improve academic performance, the brain and body become accustomed to the presence of this chemical in the body, and the longer the duration of use, the more likely the body is to depend on the drug and drinks to perform daily tasks, and because these stimulants cause the secretion of a large amount of dopamine in an abnormal way, and thus the secretion of natural dopamine becomes insufficient to feel happy and motivated in school. [6]

Importance and purpose of the study:

Non-medical use of neuropharmaceuticals generates significant discussions in medical and public health circles. The main motivation for this non-medical use of neuropharmaceuticals is to enhance cognitive function in healthy individuals beyond normal human capacity.

Aim of the study: The prevalence of stimulants among Syrian Private University students and its relationship with academic achievement and psychological state.

Methods:

A cross-sectional study conducted at the Syrian Private University, during the period from 12/1/2023 to 7/1/2024.

The students' answers, numbering 386 male and female students, were studied through a questionnaire designed with the assistance of the research supervisor (included in the appendix), containing a set of questions that serve the research objective, which were distributed electronically.

The approval of the Syrian Private University was obtained to publish the questionnaire in the university in various colleges.

Statistical analysis:

Patient data were tabulated and entered into the computer, and then the Statistical Package for the Social Sciences (SPSS) version (26) was used to analyze this data. The following statistical methods were used in the analysis:

ϖ Descriptive analysis: This consists of finding the relative frequency distributions of the categorical study variables (gender, place of residence, financial status...) and adding graphic forms to enrich the results.

ϖ Inferential analysis: This part of the analysis aims to present and interpret the results and infer from them in order to reach the study objective, by conducting the Chi Square independence test to study whether there is a relationship between two descriptive variables by applying the Chi Square statistic.

When students were asked about their use of stimulants during their university studies, only 32 students answered yes (8%), while the rest of the students did not use these stimulants (92%). The most common reason for using these stimulants among the students who used them was to stay up late and study during exams and projects, with 20 students (5%), while 5 students used these medications due to stress and recommendations from colleagues and friends (1%), while these stimulants were used by 3 students out of curiosity after hearing or reading about these compounds (1%), and 2 students used them to improve academic performance and to stay awake in lectures (1%), and finally, there were 2 students who used these medications due to a medical problem, as this type of medication was prescribed by a specialist doctor (1%) only. These stimulants were used by 23 students more than once due to staying up late and studying, at a rate of 6%, while they were used by 12 students more than once to improve academic performance, at a rate of 3%, and they were used for reasons related to work and tasks outside the scope of study, and due to pressures and recommendations from colleagues and friends by 5 and 4 students respectively, at a rate of 1% for each of the two reasons, while for five of the students, these medications were taken only once and did not use them again, at a rate of 1%. The fourth year was the year with the highest use of stimulants among students, at a rate of 4%, followed by the third year at a rate of 2%, and the rate of their use in the second, fifth and sixth years was equal among students at a rate of 1%. Nodemet 50 mg was the most commonly used stimulant by students, with 21 students (5%), while Ginkgo Biloba was used by 9 students (2%), 10 students had to increase their initial dose due to its insufficiency (3%), while the remaining 22 students did not increase their stimulant dose (6%). Stimulants had a positive effect on academic performance in 16 students (4%), while 8 students were unsure of this effect (2%), and for 8 students, these stimulants had no effect on their academic performance (2%). The largest number of students, 247 students, did not know whether stimulants are safer than non-drug stimulants such as energy drinks, at 64%, while 114 students answered that these stimulants are safer, at 30%, and the remaining 25 students answered that these drugs are not safe compared to non-drug stimulants, at 6%.

The use of stimulants that require a prescription was common for 63 students, at 16%, while 11 students answered that the use of these drugs is not common, at 3%, while the largest number of students, 312 students, did not know whether the use of these stimulants is common or not, at 81%.

73 students answered that it is easy to obtain stimulants that require a prescription, at 19%, while 132 students answered that it is not easy to obtain such drugs, at 34%, while the rest of the students did not know, at 47%. The answer of 88 students that the use of stimulants sometimes is not harmful was yes with a percentage of 23%, while 20 students answered the opposite with only 5%, while the rest of the students did not know whether the use of these drugs sometimes is harmful or not with a percentage of 72%.

The largest number of students, 215 students, were not completely sure about their full knowledge of stimulants and their side effects with a percentage of 63%, while 128 students did not know about stimulants and their side effects with a percentage of 33%, in contrast, 13 students were fully aware of stimulants and their side effects with a percentage of only 3%.

The largest number of students, 331 students, rated their academic performance as average with a percentage of 86%, while the academic performance was above average for 38 students with a percentage of 10%, while 12 students had a below average academic performance with a percentage of 3%, and finally, 5 students had an excellent academic performance with a percentage of only 1%. Regarding students’ confidence in completing their study program and obtaining the certificate, 340 students responded that they were confident at a rate of 88%, while 44 students were somewhat confident at a rate of 11%, and two students were not at all confident at a rate of only 1%. As for students’ confidence in completing the certificate on time, the largest number of them, 227 students, were somewhat confident at a rate of 59%, while 153 students were confident that they would obtain the certificate on time at a rate of 40%, and in contrast, 6 students were not at all confident that they would obtain the certificate on time at a rate of 2%. 150 students responded that they were confident in their ability to manage their time effectively at a rate of 39%, while 232 students were somewhat confident at a rate of 60%, and only 4 students were not at all confident in managing their time effectively at a rate of only 1%. 143 students were confident in their ability to deal with the academic workload and face challenges and obstacles at a rate of 37%, while the largest number of them, 240 students, were somewhat confident at a rate of 62%, and finally, there were 3 students who were not at all confident in their ability to deal with the academic load at a rate of 1%. As for the feelings of depression, anxiety and stress among students, the average stress score among them was 2.86 with a standard deviation of 3.18, and by classifying these scores, it was normal for 358 students at a rate of 93%, while the stress was mild for 9 students at a rate of 2%, and moderate for 13 students at a rate of 3%, while it was severe and very severe for 6 students at a rate of 1% each. As for the degree of anxiety, the arithmetic mean among students was 1.42 with a standard deviation of 2.42, where the largest number of students, amounting to 351 normal students at a rate of 91%, had mild anxiety at 17 students at a rate of 4%.

By studying the relationship between the personal variables of students and whether they use stimulants or not with the degree of stress, we found a strong statistically significant relationship between both female gender and the degree of stress, as the average stress among females was higher compared to males (3.10 versus 2.63), and thus the P value was equal to 0.0019, indicating a significant relationship between these two variables.

As for the financial situation, we found that the degree of stress increases with the improvement of the financial situation, as this degree was among students with excellent financial status, as it reached 7.53, and thus the P value reached < 0.0001, indicating a strong statistical relationship between these two variables.

The students of the Faculty of Human Medicine were the students who had the highest degree of stress, as it reached 4.01 compared to students of the rest of the colleges, and thus a significant relationship was found between studying human medicine and the increase in the degree of stress among students, as the P value reached < 0.0001, indicating a significant relationship between these two variables.

The stress level was highest among first-year students, reaching 8.75, compared to the rest of the academic years. The second place was for sixth-year students, which is considered the graduation year for medical students, as the stress level reached 4.4, indicating a significant relationship between these two years and an increase in the stress level, as the P value was < 0.0001, indicating a strong statistical relationship between the student's academic year and an increase in his stress level. As for the cumulative university average and its relationship to the increase in the stress level, students with averages ranging from 3.25–3.74 were the students with the highest stress level, as their arithmetic mean was 7.4, and thus the P value was 0.0035, indicating a significant relationship between the increase in the academic average and the stress level among students. Students who work alongside their studies had a higher degree of stress than students who do not work (7.10 versus 2.64), and thus the P value was < 0.0001, indicating a strong statistically significant relationship between working alongside studying and an increase in the degree of stress among these students. The same applies to the increase in the degree of stress as the number of working hours and days increases among working students, as the average degree of stress among students who work for more than 6 hours was 6, while the average degree of stress among students who work for more than 3 days a week was 7.14, indicating a significant relationship between the increase in the number of working hours and days and the increase in the degree of stress among students, as the P value was < 0.0001 for each of them. Finally, by studying the relationship between the use of stimulants among students and their level of stress, we found a strong statistically significant relationship between these two variables, as the average level of stress was higher among students who used stimulants compared to students who did not use them (6.65 versus 2.52), and thus the P value reached < 0.0001, indicating a significant relationship between the increase in stress when students use stimulants. By studying the relationship between the personal variables of students and whether they use stimulants or not with the level of anxiety, we found that the level of anxiety increases with the improvement of the financial situation, as this level was the same among students with an excellent financial situation, as it reached 4.76, and thus the P value reached 0.0007, indicating a strong statistical relationship between these two variables. The students of the Faculty of Medicine were the students who had the highest anxiety level, reaching 1.93 compared to students of the rest of the faculties. Thus, a significant relationship was found between studying medicine and the increase in the anxiety level among students, as the P value reached < 0.0001, indicating a significant relationship between these two variables. The anxiety level was highest among first-year students, reaching 5, compared to the rest of the academic years. The second place was for sixth-year students, which is considered the graduation year for medical students, as the stress level reached 2.1, indicating the existence of a significant relationship between these two years and the increase in the anxiety level, as the P value was 0.0042, indicating the existence of a strong statistical relationship between the student's academic year and the increase in his anxiety level. As for the cumulative university average and its relationship to the increase in the anxiety level, students with averages ranging from 3.25–3.74 were the students with the highest anxiety level, as their arithmetic mean reached 4.4, and thus the P value reached 0.0190, indicating the existence of a significant relationship between both the increase in the academic average and the anxiety level among students. The same applies to the relationship between the last semester percentage and the anxiety level, as it was highest among students whose average ranged between 85–94%, and thus the P value reached 0.0002.

Students who smoked had a higher anxiety level than other students, as this average reached 2.08 compared to 1.01 among non-smokers, and thus the P value was < 0.0001, indicating a significant relationship between smoking and increased anxiety levels among students.

Finally, by studying the relationship between the use of stimulants among students and their anxiety levels, we found a strong statistically significant relationship between these two variables, as the average anxiety level was higher among students who used stimulants compared to students who did not use them (4.40 versus 1.15), and thus the P value reached 0.0004, indicating a significant relationship between increased anxiety when using stimulants among students.

By studying the relationship between the students' personal variables and whether they use stimulants or not with the degree of depression, we found that the degree of depression increases with the improvement of the financial situation, as this degree was among students with excellent financial status, as it reached 4.84, and thus the P value < 0.0001, indicating a strong statistical relationship between these two variables.

The degree of depression was highest among first-year students, as it reached 8.5, compared to the rest of the academic years. The second place was for sixth-year students, which is considered the graduation year for human medicine students, as the degree of stress reached 2.57, indicating the existence of a significant relationship between these two years and the increase in the degree of anxiety, as the P value < 0.0001, indicating the existence of a strong statistical relationship between the student's academic year and the increase in his degree of depression.

As for the relationship between the percentage average in the last semester and the degree of depression, it was highest among students whose average ranged between 85–94%, as the average degree of depression reached 7.2, and thus the P value reached 0.0398. Students who work alongside their studies had a higher degree of depression than students who do not work (3.10 versus 1.38), and thus the P value reached 0.0074, indicating the existence of a strong statistically significant relationship between working alongside studying and the increase in the degree of depression among these students. The same applies to the increase in the degree of depression as the number of working hours and days increases among working students, as the average degree of depression among students who work for more or less than 6 hours was 3 and 3.11, respectively, while the students who work for more than 3 days a week had a stress degree of 3.85, indicating the existence of a significant relationship between the increase in the number of working hours and days and the increase in the degree of depression among students, as the P value reached 0.0249 and 0.0194 for each. By studying the relationship between the use of stimulants among students and their degree of depression, we found a strong statistically significant relationship between these two variables, as the average degree of depression was higher among students who used stimulants compared to students who did not use them (4.5 versus 1.19), and thus the P value reached 0.0006, indicating a significant relationship between the increase in depression when using stimulants among students.

By studying the relationship between the use of stimulants and each of the students' personal variables, we found a strong statistically significant relationship between the male patient's gender and the use of these medications, as the percentage of male students who used these stimulants was higher than the percentage of female students (75% versus 25%), and thus the P value reached 0.0038, indicating the existence of a significant relationship between these two variables.

Students with good financial status used stimulants more than the rest of the students whose financial status was average or excellent, as the percentage of these students was 72%, and thus the P value reached 0.0005, indicating the existence of a strong statistically significant relationship between these two variables. As for the relationship between the college to which students belong and its relationship to the use of stimulants among them, students of the College of Human Medicine used stimulants more (88%) than students of other colleges, whether it was a medical college such as the College of Dentistry or Pharmacy (3% for each), non-medical colleges such as the College of Petroleum Engineering, Informatics and Business Administration, and thus the P value reached < 0.0001, indicating the prevalence of stimulants among medical students and the existence of a significant relationship between these two variables. As for the relationship between the academic year and students' use of stimulants, the sixth year, which is considered the graduation year for medical students, was the year in which stimulants were used the most (66%) compared to the rest of the academic years, and thus the P value reached < 0.0001, indicating the existence of a strong statistical relationship between the academic year and the prevalence of stimulant use during it. A strong statistically significant relationship was found between smoking among students and the use of stimulants, as the percentage of smoking students who use these drugs was 59%, compared to 41% for non-smoking students, and thus the P value was 0.0129, indicating a significant relationship between these two variables.

The non-medical use of neuropharmaceuticals generates considerable debate in medical and public health circles [1, 2]. The main motivation for this non-medical use of neuropharmaceuticals is to enhance cognitive function in healthy individuals beyond normal human capacity [3, 4]. Drugs such as methylphenidate and amphetamines have sympathomimetic effects such as elevating mood, enhancing alertness, and improving memory, concentration, and learning, as major factors in the increasing prevalence of their use among college students and adults [5, 6]. Stimulants, such as methylphenidate, act similarly to neurotransmitters in the brain including norepinephrine and dopamine. These drugs enhance the effects of these neurotransmitters in the brain, and this associated increase in dopamine can induce feelings of euphoria, and they also increase blood pressure and heart rate, constrict blood vessels, increase blood glucose, and dilate bronchioles [7–10]. There is strong evidence that methylphenidate, a medication prescribed to manage symptoms of attention-deficit/hyperactivity disorder (ADHD) in children and adults, is used by healthy college students to improve concentration, alertness, and academic performance [11]. In fact, as stimulant medications have become increasingly available on college campuses, over-the-counter use of stimulant medications has been reported among college students [12–14].

Reported rates of nonmedical use vary across studies, ranging from less than 5% to nearly 20% of students in two studies conducted in the United States [15, 16]. The rate of stimulant use among students in our study was similar to the rates found in global studies, reaching 8% of all students.

As for the financial and social status among students and its relationship to stimulant use, one global study indicated that socioeconomic status and its relationship to non-medical use of medications had conflicting results [17, 18]. For example, Simoni-Wastila and Strickler (2004) identified an annual income of less than $40,000 as a protective factor against non-medical use of prescription opioids [19]. Meanwhile, sung et al. (2005) identified adolescents from lower economic status as a subgroup at particular risk for non-medical use of prescription opioids [20]. In addition, Herman-Stahl et al. (2007) found that youth from families with annual incomes between $30,000 and $75,000 were less likely to use non-medical stimulants [21]. Despite the equivocal support linking economic status to non-medical drug use, our study hypothesizes a positive relationship between these factors. Specifically, participants with a good economic status were more likely to use stimulants, followed by students with a medium economic status. This finding may be due to the fact that the category of students with a good economic status is larger than the other categories in the study, and another reason is that the economic status of Syrian students in general is related to the economic status of their families, which is currently good for most of them.

Global studies have indicated that human medical students are more at risk of using non-medical stimulants (methylphenidate and amphetamines) related to their academic conditions such as prolonged wakefulness, a series of professional exams as indicators of their competence, stress, and the need to enhance their ability to concentrate and focus in writing and studying; and finally, improve their academic performance [5, 22]. Researchers studying stimulant use among medical students have hypothesized that nonmedical use of stimulants may be related to these students’ perceived associations with academic achievement, admission to competitive programs after graduation, and desire for academic success [23].

Compared to the findings in our study, McNiel et al. (2011) [24] reported 12.4% of dental students reported nonmedical stimulant use; 10.1% of medical students reported stimulant use in Frick, Frick, Coffman, and Dey, 2011 [25]; and 11.6% of pharmacy students reported stimulant use in Tuttle, Scheurich, and Ranseen, 2010 [26]. Our study found a strong statistically significant association between male gender and the use of pharmaceutical stimulants. Global studies have indicated that the relationship between the use of non-prescribed stimulants and gender is not consistent, with several studies indicating that males are at greater risk (Emanuel et al., 2013; McCabe et al., 2005;) [27, 28], several reporting no difference (Herman-Stahl, Krebs, Kroutil, & Heller, 2007; Mache, Eickenhorst, Vitzthum, Klapp, & Groneberg, 2012) [21, 29], and at least one reporting that females are more likely to engage in non-prescribed stimulant use (Zullig and Divin, 2012) [30]. Despite these mixed results, a meta-analysis has indicated that males tend to use stimulants non-prescribed more than females. It has been suggested that moderating variables, such as differences in academic achievement or fields of study, as well as differences in methods across studies, could explain the variability in findings [31]. The results in our study indicated an association between both stimulant use and the presence of anxiety, stress, and depression among the sample students, which is consistent with the study by Dussault and Weyandt (2013) investigating the association between non-medical use of prescription stimulant medications and self-reported levels of

Ethical approval:

The Research Ethics Committee at Syrian Private University and the ethical committees at the relevant Syrian Private University approved the study protocol, Verbal informed consent was obtained from the participant All procedures performed in studies involving the participant and human subjects were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards

Consent for publication:

Not applicable.

Availability of data and materials:

All data produced in the present work are contained in the manuscript

Conflict of interest:

The authors declare that they have no Conflict of interest:

Funding:

Unavailable

Acknowledgments:

We are thankful to the management of the Syrian Private University for their support in the eld of medical training and research. We would also like to thank all doctor in our university for him help and supervision in the paper, we would like to thank the male and female students participating in the study.

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Prevalence of stimulants among students of the Syrian Private University and its relationship with academic achievement and psychological state

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