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

Saleh A. Alghamdi; Mohammed A. Aljaffer; Faisal S. Alahmari; Ahmed B. Alasiri; Abdullah H. Alkahtani; Fadhah S. Alhudayris; Bassam A. Alhusaini

doi:10.15537/smj.2023.44.6.20230055

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Table 1

- Socio-demographic characteristics of the medical students (N=1099).

Study variables	n (%)
*Age group*
18 – 20 years	187 (17.0)
21 – 23 years	549 (50.0)
24 – 26 years	311 (28.3)
>26 years	52 (04.7)
*Gender*
Male	485 (44.1)
Female	614 (55.9)
*Marital status*
Single	1013 (92.2)
Married	68 (06.2)
Divorced	16 (01.5)
Widowed	02 (0.2)
*Type of institution*
Government medical college	983 (89.4)
Private medical college	116 (10.6)
*Region of medical college*
Central Region	367 (33.4)
Northern Region	227 (20.7)
Southern Region	229 (20.8)
Eastern Region	140 (12.7)
Western Region	136 (12.4)
*Academic year level*
1st year	119 (10.8)
2nd year	131 (11.9)
3rd year	209 (19.0)
4th year	214 (19.5)
5th year	259 (23.6)
Intern	167 (15.2)
*Grade point average*
4.75–5	230 (20.9)
4.5–4.74	229 (20.8)
4–4.49	313 (28.5)
3–3.99	278 (25.3)
2.99 or less	49 (04.5)
*Personal monthly income (SAR)*
1000-2000	805 (73.2)
2000-3000	91 (08.3)
3000-4000	37 (03.4)
4000-5000	26 (02.4)
>5000	140 (12.7)
*Extra income*
Yes	366 (33.3)
No	733 (66.7)
*Source of extra income (n=366)*
Family support	301 (82.2)
Part-time job	38 (10.4)
University bonus	14 (03.8)
Others	13 (03.6)
*Living status*
With my family	925 (84.2)
With a colleague	63 (05.7)
I live alone	111 (10.1)
*Smoking*
Yes	223 (20.3)
No	876 (79.7)
*Associated chronic disease*
Yes	135 (12.3)
No	964 (87.7)
*Diagnosed with mental illness*
Yes	200 (18.2)
No	899 (81.8)
*Specific mental illness (n=200)*
Psychosis	22 (11.0)
Bipolar	17 (08.5)
Depression	93 (46.5)
Anxiety	55 (27.5)
Phobia	02 (01.0)
Others	11 (05.5)

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Table 2

- Assessment of Rosenberg’s self-esteem scale questionnaire (n=1099).

Self-esteem Statement	Mean±SD
1. On the whole, I am satisfied with myself
2. At times I think I am no good at all ^†
3. I feel that I have a number of good qualities
4. I am able to do things as well as most other people
5. I feel I do not have much to be proud of ^†
6. I certainly feel useless at times ^†
7. I feel that I’m a person of worth
8. I wish I could have more respect for myself ^†
9. All in all, I am inclined to think that I am a failure ^†
10. I take a positive attitude toward myself
Total self-esteem score	17.9 ± 5.38
Level of self-esteem
Low (<15 points)	265 (24.1%)
Normal (15-25 points)	738 (67.2%)
High (>25 points)	96 (08.7%)

↵Response has a range from “strongly disagree” coded with 0 to “strongly agree” coded with 3. ^† Score was reverse coded.

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Table 3

- Low self-esteem’s related behaviors (N=1099).

Behavior statements	Level of self-esteem
	Low	Normal/High	P-value*
	Mean±SD
Seeking professional (medical) help	2.63±0.88	2.68±0.92	0.511
Attaching to students’ study groups	2.37±0.88	2.69±0.89	<0.001**
Attending self-development programs	2.26±0.91	2.67±0.93	<0.001**
Using illicit drugs (alcohol, amphetamine, and so on)	1.49±0.86	1.47±0.85	0.719
Self-medication to increase my self-esteem	2.03±1.01	1.99±1.03	0.579
Self-injury behaviors	1.82±0.96	1.57±0.87	<0.001**
Suicidal behaviors	1.86±0.99	1.50±0.86	<0.001**
Procrastination	3.03±1.07	2.42±1.06	<0.001**
Avoiding certain situations or people	3.27±0.88	2.87±0.86	<0.001**
Quitting tasks partially	2.94±0.87	2.50±0.87	<0.001**
Rushing through work	2.85±0.89	2.56±0.82	<0.001**
Displaying an “I don’t care” attitude	2.98±0.94	2.59±0.93	<0.001**
Trying to please others all the time	2.72±1.00	2.35±0.95	<0.001**
Working excessively hard at everything I do	2.72±0.97	2.83±0.85	0.079
Trying to be perfect all of the time	3.01±0.91	2.92±0.87	0.167
Excessive competitiveness	2.57±0.99	2.57±0.90	0.999
Acting angrily if mistakes are made	2.94±0.94	2.57±0.88	<0.001**
Being unable to say no	2.83±0.93	2.49±0.91	<0.001**
Frequently putting yourself down when you speak	2.96±0.85	2.26±0.89	<0.001**
Dismissing your thoughts as unimportant to others	3.01±0.81	2.33±0.89	<0.001**
Avoiding giving your opinion or expressing your feelings	3.000.90	2.43±0.89	<0.001**
Seeking sympathy from others	2.17±0.96	2.03±0.91	0.027**
Getting other people to do things for you because you believe you aren’t capable	2.20±0.99	1.89±0.92	<0.001**
Acting in an aggressive way (such as shouting, and so on)	2.34±0.96	2.03±0.95	<0.001**
Blame others for the negative way you feel about yourself	2.28±0.99	2.00±0.93	<0.001**
Being defensive when others give you constructive criticism or feedback	2.55±0.93	2.25±0.91	<0.001**

↵Response has a range from “strongly disagree” coded with 1 to “strongly agree” coded with 4. *P-value has been calculated using an independent sample t-test. **Significant at p<0.05 level.

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Table 4

- Association between the level of self-esteem and the socio-demographic characteristics of the medical students (N=1099).

Factor	Level of self-esteem		P-value^§
Factor	Low (n=265)	Normal/High (n=834)	P-value^§
*Age group*
≤23 years	178 (67.2)	558 (66.9)	0.937
>23 years	87 (32.8)	276 (33.1)	0.937
*Gender*
Male	88 (33.2)	397 (47.6)	<0.001**
Female	177 (66.8)	437 (52.4)	<0.001**
*Type of institution*
Government medical college	237 (89.4)	746 (89.4)	0.995
Private medical college	28 (10.6)	88 (10.6)	0.995
*Region of medical college*
Central Region	89 (33.6)	278 (33.3)	0.783
Northern Region	52 (19.6)	175 (21.0)
Southern Region	51 (19.2)	178 (21.3)
Eastern Region	39 (14.7)	101 (12.1)
Western Region	34 (12.8)	102 (12.2)
*Academic year level*
Junior students	109 (41.1)	350 (42.0)	0.810
Senior students	156 (58.9)	484 (58.0)	0.810
*Grade point average*
5-4.75	43 (16.2)	187 (22.4)	0.039**
4.74-4.5	53 (20.0)	176 (21.1)
4.49-4	80 (30.2)	233 (27.9)
3.99-3	70 (26.4)	208 (24.9)
2.99 or less	19 (07.2)	30 (03.6)
*Personal monthly income (SAR)*
≤2000	198 (74.7)	607 (72.8)	0.535
>2000	67 (25.3)	227 (27.2)	0.535
*Extra income*
Yes	78 (29.4)	288 (34.5)	0.125
No	187 (70.6)	546 (65.5)	0.125
*Living status*
With my family	19 (82.6)	706 (84.7)	0.344
With a colleague	20 (07.5)	43 (05.2)
I live Alone	26 (09.8)	85 (10.2)
*Smoking*
Yes	52 (19.6)	171 (20.5)	0.756
No	213 (80.4)	663 (79.5)	0.756
*Associated chronic disease*
Yes	38 (14.3)	97 (11.6)	0.242
No	227 (85.7)	737 (88.4)	0.242
*Diagnose with mental illness*
Yes	75 (28.3)	125 (15.0)	<0.001**
No	190 (71.7)	709 (85.0)	<0.001**

↵ ^§ P-value has been calculated using Chi-square test, **significant at p<0.05 level.

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Table 5

- Multivariate regression analysis to determine the independent significant factor associated with low self-esteem (N=1099).

Factor	AOR	95% CI	P-value
*Gender*
Male	Ref
Female	1.851	1.365 – 2.511	<0.001**
*Grade point average*
5-4.75	0.726	0.458 – 1.151	0.173
4.74-4.5	0.614	0.401 – 0.941	0.025 *
4.49-4	0.574	0.368 – 0.894	0.014**
3.99-3	0.308	0.155 – 0.612	0.001**
2.99 or less	Ref
*Diagnose with mental illness*
Yes	1.971	1.408 – 2.759	<0.001**
No	Ref