The impact of low self-esteem on academic achievement and the behaviors related to it among medical students in Saudi Arabia

Discussion

This study evaluated the self-esteem of medical students, the behaviors related to it, and how academic performance affects self-esteem. The findings of this study revealed that nearly one-fourth (24.1%) of the medical students demonstrated low self-esteem, 67.2% were normal, and only 8.7% had high self-esteem; this was consistent with the study of Alsaleem et al.⁹ According to their report, low self-esteem was found in 23.6% of the medical students, and this has been experienced mainly by students who were in the early years of the academic year levels, specifically females; this has been concurred by Gidi et al¹² wherein 19% of the medical students exhibited low self-esteem and 19.7% were distressed. Self-esteem would have been affected by medical students’ mental health conditions, which could lead to Low self-esteem. Thus, early intervention is imperative for those showing signs of low self-esteem. Coping strategies to boost student morale could be one of the most essential steps to improving learners’ self-esteem. Another study showed that students are at the edge of self-criticism and low self-esteem, to the extent that they do not even feel themselves capable of undertaking tasks within their abilities.¹⁶ Furthermore, another study highlighted those medical students had high levels of distress for multiple reasons, and they exhibited low self-esteem. It was also found that nearly one out of 2 medical students suffered from burnout issues.¹⁷ Another study carried out in China included 30,817 Chinese medical students and found that these medical students had a relatively low prevalence of eating disorders but a high prevalence of depression, anxiety, and suicidal ideation.¹⁸

Female medical students who had been diagnosed with mental illness were the significant recipients who suffered from low self-esteem. Consistent with the present findings, a study carried out among health science students in Riyadh¹⁰ reported that any students with an underlying disease were predicted to exhibit signs of low self-esteem and had more negative feelings than normal students. Another study carried out in Pakistan¹⁴ revealed a significant difference in self-esteem scores between males and females, suggesting that male university students demonstrated higher self-esteem scores than female university students. In contrast, a study on Chinese medical students does not show significant differences among the genders.¹⁸

A different study found that students who perform well academically may not necessarily have high subjective well-being levels. In fact, the study suggests that there may even be cases where high-achieving students have low levels of subjective well-being.¹⁹ More investigations are warranted to establish the level of self-esteem in males and females with underlying diseases.

Several papers concluded that low self-esteem correlated to poor academic performance. For instance, Alyami et al¹¹ documented that there was a weak but significant correlation between self-esteem and academic performance along with self-efficacy. Studies conducted by Afari et al¹³ and Correlating²⁰ found a positive association between global self-esteem and academic self-efficacy, while academic achievement might positively influence academic self-efficacy. Another study published by Hyseni Duraku and Hoxha²¹ noted that a higher level of self-esteem was influenced by a student’s success. This is also true for the current study, as it was found that medical students’ increased academic GPA ratings were correlated with better self-esteem. However, a study published by Baumeister et al⁵ clarified that the moderate links between school performance and self-esteem do not suggest that high self-esteem was due to good performance at school; instead, it is just partly the result of good school performance. Further, it was indicated that attempts to lift students’ self-esteem did not indicate increasing academic performance and might sometimes be the opposite. Similarly, another study revealed that increased academic performance was moderately and significantly associated with student engagement.²²

When measuring the possible behaviors related to self-esteem, it was also discovered that students who frequently attended a study group and self-development programs might have better self-esteem than the other students. In a study published by Mete,²⁴ among secondary-level science students, it was observed that positive coping and projective coping strategies were seen among students, while students shown to have non-coping strategies were predicted to impact self-efficacy negatively. However, the fear of losing one’s self-esteem negatively affected self-efficacy. In a review article published by Baumeister et al⁵ they discovered that people with high self-esteem asserted themselves as more likable, more attractive, could have better relationships, and had a higher impression on others. However, objective measures contradicted these beliefs. Another study by Li J et al²⁴ showed that self-esteem is mediated by social support and improves emotional exhaustion and academic achievement.

Students in medical schools might be prone to adversities that affect their mental condition. Therefore, issues that affect their mental health should be discussed and addressed. Strategies to improve students’ self-esteem are vital in educational systems. Hence, the role of mental health services is imperative.

Although our study addresses an important topic that needs to be adequately studied in Saudi Arabia, it has certain limitations. The researchers developed the behavioral questionnaire; hence, it was not a well-established, standardized questionnaire. Additionally, the online questionnaire distribution usually bears a higher degree of selection bias. Moreover, generalizability was limited because the findings based on a survey included medical students residing exclusively in Saudi Arabia. In addition, the study tried to reveal the behaviors linked to low self-esteem among medical students without addressing the explanation of that behaviors. To overcome the following limitations, we recommend generating a standardized questionnaire that can be generalized to any country or center. Moreover, if additional studies are to be conducted regarding this topic, reporting the explanation of that behaviors can be beneficial to build more research on it.

In conclusion, one out of 4 medical students was assumed to have low self-esteem. Female medical students who had been diagnosed with mental illness were found to demonstrate low self-esteem more than others. Further, the improved GPA ratings positively influenced self-esteem, while positive behavior towards attending students’ study groups and self-developmental programs were identified as protective factors for low self-esteem. Low self-esteem is negatively affected by the mental condition of medical students. Hence, improved behavior among this group of students is vital to boost self-esteem in addition to periodic counseling. More research is needed to shed more light on the self-esteem of medical students, their behavior on it, and how it correlates to academic performance.