Nursing Students' Perceptions of Effective Factors on Mental Health: A Qualitative Content Analysis

Document Type : Original Article


1 Department of Medical-Surgical Nursing, School of Nursing, Khoy University of Medical Sciences, Khoy, Iran

2 Reproductive Health Research Center, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran


Background: Mental health is a fundamental and widespread concept with individual meanings. The purpose of this study is to perceive and clarify the factors influencing mental health from the perspectives of nursing students.
Method: The present qualitative study was conducted in Khoy, Iran from July-December 2018. Twenty nursing students were selected as the research participants through purposeful sampling method and interviewed using semi-structured in-depth interviews. All interviews were recorded, transcribed, and then analyzed with Graneheim and Lundman's approach of conventional content analysis. The Trail version of the MAXQDA 10 software was applied to conduct the coding process.
Results: Data analysis revealed four themes and 12 sub-themes. The themes included feeling of self-worth, religious beliefs, socio-economic factors, and behavioral factors.
 Conclusion: The results showed that mental health in nursing students is a multidimensional phenomenon and is influenced by various factors. The current results could help the nurse educators to intervene and provide suitable, effective, practicable, and culture based mental health services and also help the nursing students achieve mental stability. Therefore, it is suggested that further qualitative and interventional studies should be conducted in this area.


  1. Gulliver A, Griffiths KM, Mackinnon A, et al. The mental health of Austalian elite athletes. Journal of Science and Mmedicine in Sport. 2015;18:255-61.
  2. Huber M, Knottnerus JA, Green L, et al. How should we define health? British Medical Journal. 2011;343:d4163.
  3. Thorogood M, Coombes Y. Evaluating health promotion: practice and methods. 3rd ed. Oxford (UK): Oxford University Press; 2010.
  4. Karaca A, Yildirim N, Cangur S, et al. Relationship between mental health of nursing students and coping, self-esteem and social support. Nurse Education Today. 2019;76:44-50.
  5. World Health Organization. Atlas: nurses in mental health 2007. Geneva: World Health Organization; 2007.
  6. Rezaei T, Bayani AA, Shariatnia K. The prediction of mental health based on variables of Self-esteem, life satisfaction and hope among College students. Iranian Journal of Health Education and Health Promotion. 2015;3:242-52. [In Persian]
  7. Büssing A, Balzat HJ, Heusser P. Spiritual needs of patients with chronic pain diseases and cancer-validation of the spiritual needs questionnaire. European Journal of Medical Research. 2010;15:266-73.
  8. Pacheco JP, Giacomin HT, Tam WW, et al. Mental health problems among medical students in Brazil: a systematic review and meta-analysis. Brazilian Journal of Psychiatry. 2017;39:369-78.
  9. Wang AH, Lee CT, Espin S. Undergraduate nursing students’ experiences of anxiety-producing situations in clinical practicums: A descriptive survey study. Nurse Education Today. 2019;76:103-8.
  10. Wege N, Muth T, Li J, Angerer P. Mental health among currently enrolled medical students in Germany. Public Health. 2016;132:92-100.
  11. Rathnayake S, Ekanayaka J. Depression, anxiety, and stress among undergraduate nursing students in a public university in Sri Lanka. International Journal of Caring Sciences. 2016;9:1020-32.
  12. Pulido-Martos M, Augusto-Landa JM, Lopez-Zafra E. Sources of stress in nursing students: a systematic review of quantitative studies. International Nursing Review. 2012;59:15-25.
  13. Zare N, Parvareh M, Noori B, Namdari M. Mental health status of Iranian university students using the GHQ-28: a meta-analysis. Scientific Journal of Kurdistan University of Medical Sciences. 2016;21:1-16. [In Persian]
  14. Shariati M, Kaffashi A, Ghalehbandi M, et al. Mental health in medical students of the Iran University of Medical Sciences. Payesh. 2002;1:29-37. [In Persian]
  15. Kamimura A, Trinh HN, Johansen M, et al. Perceptions of mental health and mental health services among college students in Vietnam and the United States. Asian Journal of Psychiatry. 2018;37:15-9.
  16. Greczanik HM, Lupico VA. The Relationship between Stress and Social Support in Baccalaureate Nursing Students. [projrct]. Akron (US): University of Akron (Honors Research Projects); 2016.
  17. Alimohammadzadeh K, Akhlaghdoust M, Bahrainian SA, Mirzaei A. Survey on Mental Health of Iranian Medical Students: A Cross-sectional Study in Islamic Azad University. Shiraz E-Medical Journal. 2017;18:e14929.
  18. Shojaee F, Abolhassan R, Ebrahimi S, et al. Nursing students’ happiness status. Iranian Journal of Medical Education. 2011;11:161-2.
  19. Jun W, Jo M. Factor affecting happiness among nursing students in South Korea. Journal of Psychiatric and Mental Health Nursing. 2016;23:419-26.
  20. Holloway I, Galvin K. Qualitative research in nursing and healthcare. 4thed. New Jersey (US): Wiley-Blackwell; 2016.
  21. Graneheim UH, Lindgren BM, Lundman B. Methodological challenges in qualitative content analysis: A discussion paper. Nurse Education Today. 2017;56:29-34.
  22. Donsbach W. The International Encyclopedia of Communication. US: Wiley-Blackwell; 2008.
  23. Liu H, Zhang X, Chang R, Wang W. A research regarding the relationship among intensive care nurses’ self-esteem, job satisfaction and subjective well-being. International Journal of Nursing Sciences. 2017;4:291-5.
  24. Ruz MEA, Al-Akash HY, Jarrah S. Persistent (Anxiety and Depression) Affected Academic Achievement and Absenteeism in Nursing Students. The Open Nursing Journal. 2018;12:171-9.
  25. Parvizi S, Hamzehgardeshi Z. Adolescents’ view of health concept and its risk factors: a literature review. International Journal of Adolescent Medicine and Health. 2014;26:351-9.
  26. Gulec*Oyekcin D, Sahin EM, Aldemir E. Mental health, suicidality and hopelessness among university students in Turkey. Asian Journal of Psychiatry. 2017;29:185-9.
  27. Behere PB, Das A, Yadav R, Behere AP. Religion and Mental Health. Indian Journal of Psychiatry. 2013;55:S187-S94.
  28. Bakhshi*Arjenaki B, Sharifi T, Ghasemi*Pirbalouti M. Assessment the relationship of psychological well-being with religiosity attitude, self-esteem and psychological hardiness by Equation Structural Modeling among students of Islamic Azad and public universities in Shahrekord. Journal of Health Promotion Management. 2015;4:60-9. [In Persian]
  29. Harandi TF, Taghinasab MM, Nayeri TD. The correlation of social support with mental health: A meta-analysis. Electronic Physician. 2017;9:5212-22.
  30. Rothon C, Head J, Klineberg E, Stansfeld S. Can social support protect bullied adolescents from adverse outcomes? A prospective study on the effects of bullying on the educational achievement and mental health of adolescents at secondary schools in East London. Journal of Adolescence. 2011;34:579-88.
  31. World Health Organization. Impact of economic crises on mental health. Geneva: World Health Organization; 2011.
  32. Silva M, Resurrección DM, Antunes A, et al. Impact of economic crises on mental health care: a systematic review. Epidemiology and Psychiatric Sciences. 2018;29:e7.
  33. Primack BA, Land SR, Fan J, et al. Associations of mental health problems with waterpipe tobacco and cigarette smoking among college students. Substance Use & Misuse. 2013;48:211-9.
  34. AlSwuailem AS, AlShehri MK, Al-Sadhan S. Smoking among dental students at King Saud University: Consumption patterns and risk factors. The Saudi Dental Journal. 2014;26:88-95.
  35. Zhang MWB, Lim RBC, Lee C, Ho RCM. Prevalence of internet addiction in medical students: a meta-analysis. Academic Psychiatry. 2018;42:88-93.
  36. Parvizi S, Ahmadi F, Mirbazegh S. Concept and Factors Concerning to Health in an Adolescent’s Point of View. Shahrekord University of Medical Sciences Journal. 2012;14:108-20. [In Persian]
  37. Anand N, Thomas C, Jain PA, et al. Internet use behaviors, internet addiction and psychological distress among medical college students: A multi centre study from South India. Asian Journal of Psychiatry. 2018;37:71-7.
  38. Khalil AI, Alharbi NB, Alhawasawi HY, Albander AB. Prevalence of Internet addiction among nursing students and the association with their academic performance and mental health. Athens Journal of Health. 2016;3:291-306.