Relationships among symptoms of bulimia nervosa, academic stress, self-esteem and depression in female international university students

Abstract

This study aimed to determine the relationships among symptoms of bulimia nervosa, academic stress, self-esteem, and depression in female international university students. 83 participants were selected from female international students at a university in South Korea by the convenience sampling method. Both online and offline self-reported instruments were administered among participants. Symptoms of bulimia nervosa, academic stress, self-esteem, and depression were measured by Bulimia Test-Revised (BULIT-R), the Perception of Academic Stress Scale (PAS), Rosenberg Self-Esteem Scale (RSES) and the Center for Epidemiologic Studies Depression Scale (CES-D), respectively. Data analysis was conducted using descriptive statistics, ANOVA, and Pearson’s correlation with the IBM SPSS program version 25.0. The findings were as follows: 1. The mean score of bulimia nervosa of the participants was 60.23 ± 20.27, and 4 participants had symptoms of bulimia nervosa. 2. Moderate and high levels of academic stress, self-esteem, and depression were found among participants. The mean scores of academic stress, self-esteem, and depression were 52.11 ± 12.67, 26.66 ± 4.95, and 25.55 ± 8.70, respectively. 3. According to general characteristics, there was a statistically significant difference in symptoms of bulimia nervosa categorized by binge eating experienced (F = 28.546, p < .001), participants who had binge eating experienced in the last 3 months had higher scores of bulimia nervosa than non-experienced participants. Furthermore, symptoms of bulimia nervosa were differed significantly according to body image concerned (F = 12.842, p < .001), participants who always concerned about body shape and weight gain had higher scores of symptoms of bulimia nervosa than other groups. In addition, symptoms of bulimia nervosa were different by food diet experienced (F = 10.414, p = .002), excessive exercise experienced (F = 6.213, p = .015), and body mass index (BMI) (F = 3.764, p = .014), respectively. 4. The differences in depression were associated with body image concerned (F = 4.454, p = .003), and binge eating experienced (F = 5.668, p = .020). Participants who had binge eating experienced in the last 3 months and concerned about their body image had higher depression scores. However, symptoms of bulimia nervosa, academic stress, self-esteem, and depression were not significantly differed by regional groups, age, marital status, academic major fields, academic degree, academic year, accommodation, and the person whom participants were living. 5. Symptoms of bulimia nervosa had statistically significant negative correlations with self-esteem (r = -.405, p < .001). However, there was a significant positive correlation between symptoms of bulimia nervosa and depression (r = .409, p < .001). A statistically significant positive correlation was found between academic stress and depression (r = .435, p < .001). In addition, strong negative correlation was found between self-esteem and depression (r = -.664, p < .001). However, the study found no significant correlation between symptoms of bulimia nervosa and academic stress (r = .191, p = .083) and between academic stress and self-esteem (r = -.181, p = .102). Thus, this study demonstrated that symptoms of bulimia nervosa were significantly associated with self-esteem and depression, but the relationships between symptoms of bulimia nervosa and academic stress were not statistically significant in female international university students. According to the results, identifying causal factors of bulimia nervosa could provide the application of psychological health screening at the universities as well as clinical settings, along with the development of nursing education, nursing practice, and nursing research.;본 연구의 목적은 여성 국제 대학생의 신경성 폭식증, 학업 스트레스, 자아존중감, 우울 간의 관계를 파악하는 것이다. 본 연구는 한국의 1 개 대학에서 83 명의 여성 국제 대학생을 편의추출하여 온/오프라인으로 설문지를 배부하였다. 신경성 폭식증을 측정하기 위해 Bulimia Test – Revised (BULIT-R) 도구를 사용하였고, 학업 스트레스는 Perception of Academic Stress Scale (PAS) 로 측정하였으며 , 자아존중감은 Rosenberg Self-Esteem Scale(RSES), 우울은 Center for Epidemiologic Studies Depression Scale (CESD) 을 사용하여 측정하였다. 자료는 IBM SPSS 프로그램 25.0 을 이용하여 기술적 통계, ANOVA, Pearson’ s correlation 으로 분석하였다. 연구 결과는 다음과 같다. 1. 대상자의 신경성 폭식증은 평균 60.23 ± 20.27 점이었으며 , 4 명이 식욕 부진이 있는 것으로 나타났다. 2. 대상자의 학업 스트레스는 평균 52.11 ± 12.67 점 , 자아존중감은 평균 26.66 ± 4.95 점 , 우울은 평균 25.55 ± 8.70 점이었다. 대상자의 학업 스트레스, 자아존중감, 우울은 중등도에서 고도 수준인 것으로 나타났다. 3. 대상자의 신경성 폭식증은 폭식 경험 (F = 28.546, p < .001), 신체상 염려 (F = 12.842, p < .001), 식단 관리 경험 (F = 10.414, p = .002), 과도한 운동 경험 (F = 6.213, p = 015), 체질량지수 (BMI)(F = 3.764, p = 0.014) 에 따라 유의한 차이가 있는 것으로 나타났다. 지난 3 개월 이내 폭식을 경험한 대상자들이 폭식 경험이 없는 대상자보다 신경성 폭식증 점수가 높았으며 , 체형과 체중 증가에 대해 염려하는 대상자가 더 높은 신경성 폭식증 점수를 나타냈다. 4. 우울은 신체상 염려 (F = 4.454, p = .003), 폭식 경험 (F = 5.668, p = 0.020) 에 따라 유의한 차이가 있었다. 지난 3 개월 이내 폭식을 경험한 경우, 신체상에 대해 염려하는 경우 더 높은 우울 수준을 보였다. 그러나 신경성 폭식증, 학업 스트레스, 자존감과 우울은 지역사회 , 연령 , 결혼 상태, 전공, 학위 , 학년, 주거 상태, 생활 환경에 따라 유의한 차이를 나타내지 않았다. 5. 신경성 폭식증은 자아존중감과 유의한 음의 상관관계를 나타냈고 (r = -.405, p < .001), 우울과 양의 상관관계를 나타냈다 (r = .409, p < .001). 학업 스트레스와 우울은 유의한 양의 상관관계를 보였으며 (r = .435, p < .001), 자아존중감은 우울과 음의 상관관계를 나타냈다 (r = -.664, p < .001). 그러나 신경성 폭식증과 학업 스트레스 (r = 191, p = 0.083), 학업 스트레스와 자아존중감 (r = -.181, p = 1.02) 간에는 유의한 상관관계가 나타나지 않았다. 본 연구에서 여성 국제 대학생의 신경성 폭식증은 자아존중감, 우울과 관련이 있는 것으로 나타났다. 따라서 이를 고려하여 신경성 폭식증의 관련 요인을 파악하는 것은 간호 교육, 간호 실무, 간호 연구의 발전과 함께 임상 실무 및 간호 교육 환경에서 심리적 건강 선별 검사의 적용에 기여할 것으로 생각된다.