title: Symptoms and health complaints and their association with perceived stress at university: survey of students at eleven faculties in Egypt.
abstract: OBJECTIVE
  This study examined the relationships between perceived stress and a range of self reported symptoms and health complaints in a representative sample of students at one university in Egypt.
  
  
  METHODS
  The data (3,271 students) was collected during the academic year 2009-2010 at eleven faculties at the university of Assiut city, Egypt. A self-administered questionnaire measured health complaints (22 symptoms) and Cohen's Perceived Stress Scale. Socio-demographic and lifestyle data were also collected. Factor analysis generated four groups of health complaints: psychological, circulatory/breathing, gastrointestinal, and pains/aches, and the internal consistency of each group of symptoms was computed using reliability analyses (Cronbach's alpha). Perceived stress was categorized into four levels based on quartiles. Multiple binomial or multinomial logistic regression analyses analysed the relationship between each of the four groups of symptoms and other students' general characteristics adjusted for the effect of all other groups of symptoms.
  
  
  RESULTS
  The symptoms most often reported as having occurred sometimes/very often in the last 12 months were fatigue (85.3%), difficulties to concentrate (78.1%), headache (77.9%), and mood swings (74.5%), while nervousness/anxiety (63.2%) and sleep disorder (63.7%) affected many students. Multinominal logistic regression revealed a clear association and a linear trend between increasing level of stress and a higher frequency of psychological symptoms that remained significant after adjustment for other groups of symptoms. There were no associations between perceived stress and circulatory/breathing symptoms, gastrointestinal symptoms, or for pains/aches. Poor health was consistently associated with higher frequency of symptoms across all symptom groups except for gastrointestinal symptoms. Higher health awareness was associated with lower frequency of psychological and circulatory/breathing symptoms but not for the other two symptom groups. Better quality of life was associated with lower frequency of psychological and partly for circulatory/breathing symptoms, but not for the other two symptom groups. There were differences in levels of psychological symptoms and of perceived stress between faculties, where students of Physical Education showed the lowest risk profile regarding both psychological symptoms and perceived stress, while students of Veterinary Medicine showed the highest risk profile. Across all four symptom groups, females had higher ratings of complaints than males.
  
  
  CONCLUSIONS
  The high prevalence of health complaints especially of psychological and pains/aches type of symptoms raise concern and calls for preventive actions at universities. Comprehensive programmes would be recommended that take the co-occurence of perceived stress and health complaints into account.
authors.forename: Walid
authors.initials: W
authors.lastname: El Ansari
authors.forename: Reza
authors.initials: R
authors.lastname: Oskrochi
authors.forename: Shokria
authors.initials: S
authors.lastname: Labeeb
authors.forename: Christiane
authors.initials: C
authors.lastname: Stock
mesh_terms: D000328:Adult; D004534:Egypt / Q000453:epidemiology; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008297:Male; D010465:Perception; D015995:Prevalence; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D013334:Students / Q000523:psychology*; D011795:Surveys and Questionnaires; D014495:Universities