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Table of Content Volume 6 Issue 2 - May 2018

A cross-sectional study on homesickness among the first year medical students of a medical college in South India

 

Sudhir B Nelson1, Vishnu G Ashok2*, Gleffi Bensher3, Getsy Benita4

 

1,2Assistant Professor, 3,4Intern, Department of Community Medicine, Sree Mookambika Institute of Medical Sciences, Kulasekaram-629161, INDIA.

Email: vishnusastha@gmail.com

 

Abstract               Background: India’s education levels are improving and an increasing number of students are leaving the comforts of their home to pursue a higher education. The transition to college can be an exciting new experience, but intense homesickness can create a difficult or even unsustainable situation. Despite various efforts, counselling centres is still not a norm in most institutes in the country. Majority of the students in a medical college are from distant places. Thus they may be susceptible to homesickness. Objective: To study the prevalence of homesickness and factors influencing it among first year medical students was undertaken in a medical college situated in south India. Materials and Methods: A cross-sectional study was carried out among the first year MBBS students Between January- February 2017. A modified version of the Homesickness Questionnaire (HQ) initially developed by Archer et al was used to measure homesickness. 93 students residing in the hostel were included in the study. Results: In our study, age of the participants ranged from 17 to 20 years and there were 54 (58.1%) female students and 39 (41.9%) male students. Out of the 93 students 87 i.e. 93.55% were homesick. Among the students who are homesick, a majority of them, i.e. 58 students (66.66%) were moderately homesick. Higher age i.e. 19 and 20 years was significantly associated with homesickness (p-value < 0.001). Students whose family is situated more than 500 km were more likely to be homesick (p-value < 0.001). There was a weak, but significant negative correlation between homesickness and academic performance. (r = 0.335 and p-value < 0.001). Conclusion: Prevalence of Homesickness is quite high among first year medical students and it has a negative impact on Academic performance. There is urgent need for remedial measures including setting up of student counselling centres in all medical colleges.

Key Words: Academic performance, Homesickness, Medical students.

 

 

INTRODUCTION

Education is an important pillar of a country’s development. Over the years, a Degree is slowly becoming a minimum qualification in many areas in the country. In the past four decades, the number of universities has increased by 6 times and college enrolment has increased by 12 times. At the start of this decade, India stood second in terms of enrolment in higher education.1 As the education levels in India has improved, the trend of attending the nearest college to obtain some Degree is changing to moving across the country or even outside to pursue a course of choice. Thus, an increasing number of students are leaving the comforts of their home to pursue a higher education. Although this is leading to better-educated individuals, many a time this has also lead to social and psychological problems among the students. This is becoming more pronounced as the families are shifting towards smaller family sizes and the children are coddled at home. The problem is complicated by the period at which the shift from home to college takes place i.e. Adolescence. This is a stage of significant psychological development in a human being’s life. During this period they are allowed increased independence by the parents and there is less supervision. When they are at home, they always have a social safety net of parenthood to fall back during difficulties. But when they leave their home, their entire social environment changes during a time at which the psychological maturity is not guaranteed. The transition to college or university can be an exciting new experience for many young adults. Conversely, intense homesickness can create a difficult or even unsustainable situation. Homesickness is defined as the distress or impairment caused by an actual or anticipated separation from home.2 It was most commonly associated with depressive symptoms and internalizing behaviour problems. Homesickness intensity generally decreases with increasing age and as the person gains separation experience.3 It was found that homesickness can be an emotional mixture of anxiety and depression.4 Studies suggest that homesickness can precipitate new mental and physical health problems. It can exacerbate pre-existing mood and anxiety disorders, and can even lead to dropping out of college altogether.2 Moreover, homesickness has also reported to being associated with poor sleep quality among students.5 There have been sporadic reports of students taking the extreme step of suicide due to homesickness across India.6,7 In most of the large universities across the globe, handling of homesickness is an essential service provided to the students by the institutes. But this is not the norm in India. There have been efforts in India to include guidance and counselling services in educational institutes since independence. The Mudaliar Commission on secondary education (1952-53) suggested that guidance should be an integral part of education. Education Commission (1964-66) recommended that guidance and counselling should be started at the primary school itself. In the following decades, various educational guidelines and frameworks tried to make counselling an integral part of education, but most of them have been unsuccessful.8 Even now, in the world of Indian education, the word counselling is associated with career guidance rather than emotional or psychological guidance. It has been observed that Medical education is one of the toughest education with its own stressors. Most of the students in a medical college travel far from home in order to pursue their dream of becoming a doctor. Hence, almost all of them suffer from a sudden loss of immediate support from their family. The transition from home to living away from home represents a significant transition for the first-year students. For most students, the experience is an adventure, both socially and intellectually. For others, the experience might be overwhelming and distressing. Although some new students have previous experience of staying away from their parents, most of the time they are of short duration. They are also the focus of their parents’ dreams and consequently are under pressure to perform well academically. Nevertheless, all students must face the challenge of managing their own life independently. One of the commonest problems faced by the students when they shift from school to a college away from home is Homesickness. Changes in diets, social setting, and geographical areas can induce intense homesickness. A study in south India showed that the prevalence of depression was 64% among medical students.9 Extrapolating from this, we can infer that prevalence of homesickness might also be high among the medical students. There is a paucity of studies on homesickness in India. Most studies across the globe also focus on international students and not on inter-country or interstate migration. Hence, a study on the prevalence of homesickness and factors influencing it among medical students was undertaken in a medical college situated in Kanyakumari district of south India.

MATERIALS AND METHODS

A cross-sectional study was conducted among the first year MBBS students of a medical college situated in Kanyakumari district of south India. The study was conducted from January to February 2017, approximately six months after they joined the course. The yearly MBBS batch is made up of 100 students. All the first year students who are residing in the hostel were asked to participant in the study. Those who are not willing were excluded from the study. Ethical clearance was obtained and we collected informed consent from all of the study participants. Homesickness was measured using 28 item questionnaire based on the Homesickness Questionnaire (HQ) developed by Archer et al.10,11 Based on the total score, the students were classified as not homesick, mildly homesick, moderately homesick and extremely homesick. The average score of each student in the first internal assessment of all three first-year subjects was taken as a proxy for academic performance. The Data collected from through the questionnaire was entered into Microsoft Excel and analysis was done using GNU pspp software, version: 1.0.1. Descriptive statistics were used to describe the basic characteristics of the participants and the outcome variables. Pearson’s correlation was applied to test the association between homesickness and age, sex and distance from home. A relationship was considered to be statistically significant if the P value was < 0.05.


OBSERVATIONS AND RESULTS

 

Table 1: Influence of age on Homesickness

Age

Not Homesick

Mildly homesick

Moderately homesick

Severely homesick

Total

17

3 (75%)

0

1 (25%)

0

4 (100%)

18

3 (5.88%)

2 (3.92%)

33 (64.71%)

13 (25.49%)

51 (100%)

19

0

6 (21.43%)

20 (71.43%)

2 (7.14%)

28 (100%)

20

0

6 (60%)

4 (40%)

0

10 (100%)

Total

6 (6.45%)

14 (15.05%)

58 (62.37%)

15 (16.13%)

93 (100%)

Pearson Chi-Square value = 33.79 P value < 0.001

Table 2: Influence of distance from family on homesickness

Distance from family

Not Homesick

Mildly homesick

Moderately homesick

Severely homesick

Total

Upto 500 km

6 (7.23%)

8 (9.64%)

56 (67.47%)

13 (15.66%)

83 (100%)

> 500 km

0

6 (60%)

2 (20%)

2 (20%)

10 (100%)

Total

6 (6.45%)

14 (15.05%)

58 (62.37%)

15 (16.13%)

93 (100%)

Pearson Chi-Square value = 40.46 p value < 0.001


Out of the 100 first-year students, 6 were day scholars. The rest were requested to participate in the study. One student did not wish to be part of the study and hence, the final study population was 93. The age of the participants ranged from 17 to 20 years. 18 years was the most common age (54.8%) followed by 19 years (30.1%). There were 54 (58.1%) female students and 39 (41.9%) male students among those who participated in the study. All of them have studied in English medium schools. There were 83 students who came from a distance of up to 500 km and 10 students whose family is residing at a distance of greater than 500 km. When it came to academic performance, 59 students (63.44%) have an average pass mark of 50 percentage and the remaining 34 students scored less than that. Out of the 93 study participants, 87 students i.e. 93.55% were homesick. Among the students who are homesick, a majority of them, i.e. 58 students were moderately homesick. (Figure 1) Age of the participants had a significant association with the presence of Homesickness. All the students who were 19 and 20 years of age were homesick. (P-value< 0.001). (Table 1) Sex of the student did not have any significant association with homesickness (p-value = 0.11). But there were considerably more girls in the moderately homesick group compared to boys. (Figure 2) Distance of greater than 500 km from the family of the participants have a significant association with presence of Homesickness. All the students whose family is situated more than 500 km were homesick (p-value < 0.001). But most of them i.e. 60% had mild homesickness. (Table 2) The correlation analysis showed that there was a weak negative relationship between homesickness and academic performance (r = 0.335) and also that the correlation between these two variables was significant (p-value < 0.001).

 

DISCUSSION

Our study revealed an overall homesickness prevalence of 93.55%. A study done among dental postgraduates from different parts of India revealed that 90% of them have some level of homesickness that is leading to stress.12 Among students of professional colleges in Andhra Pradesh, India, 33% required counselling for homesickness.13 A study done in Kuala Lumpur, Malaysia by Majid Shahmohammadi, among Iranian students of Malaya University found that 44.3% of the participants experience homesickness.14 Fisher and Hood reported a 33% prevalence of homesickness among first-year residential students in a university in United Kingdom(UK).15 Another study by Fisher et al. revealed a prevalence of 60% among first-year university students in the UK.16 The variations might be due to the difference in study settings, the method of measurement of homesickness etc. Age of the participants had a significant association with the presence of Homesickness. All the students who were 19 and 20 years of age were homesick. According to a systematic review done on homesickness, there has been conflicting data on the influence of age in the development of homesickness.17 It depends on the age group studied, the makeup of the group, and duration of stay away from home. All of our study participants are at the same academic level and most of them would have spent their life at home until 6 months prior. Therefore, we may conclude that those who spend a greater amount of time at home prior to shifting to college are more prone to develop homesickness. In our study all the students whose family is situated more than 500 km were homesick, but a majority of them had mild homesickness. This is in agreement with the findings of a study by Fisher et al. that concluded that a geographical move is necessary for a homesickness experience but this in itself is not sufficient to cause it.18 The geographical distance was found to be associated with homesickness in a group of first-year university students studied by Fisher et al. in the UK.16 However, a study by Thurber and Sigman found that homesickness among adolescent boys was not related to distance from home.19 This study was done in a summer camp and hence the distance involved might not be large. This might be the reason for such a result. Sex of the student did not have any significant association with homesickness. The Kandi study in Andhra also did not show a statistically significant difference between males and females in terms of homesickness.13 There was no significant gender difference on homesickness (t = -.207, p > 0.05) among young adults according to a study done in Punjab, India by Palai and Kumar.20 Similarly, no difference was found between male and female students in terms of their Homesickness in a study done by Patil et al. in Dharwad, Karnataka.21 Fisher and Hood also found no sex differences in homesickness reported among university students in the UK.15 Conversely, the Shahmohammadi study found a significant association between homesickness and female sex among students of Malaya University.14 Stroebe et al. also reported female first-year students in the UK experience more homesickness compared to males.22 In our study, there was a weak negative correlation between homesickness and academic performance. Similar findings were reported by various studies across the globe. A study done by Burt among university students in Australia showed that homesickness may reduce concentrating ability, but it is not sufficient to cause a significant decrease in academic ability.23 A longitudinal study by Fisher and Hood reported higher levels of cognitive failure among university students who experienced homesickness.24 Sun et al. also reported that Homesick distress resulted in a small but significant impact on the academic performance.25 The study was done in only one medical college and hence the sample population was limited. The social environment may vary between medical colleges within South India itself and hence the findings may not be generalizable to all medical students in South India. However, the study does point towards the fact that homesickness is quite common among medical students of south India.

 

CONCLUSION

Homesickness is highly prevalent among the first year Medical students of south India with a significant percentage having moderate to severe homesickness. Gender did not have any influence on homesickness while age and distance from home influenced the development of homesickness. Homesickness also had a negative impact on the academic performance. Given the high prevalence of homesickness in medical students, there is an urgent need for setting up formal counselling centres within the medical teaching institutes in our country. The students should also be educated about homesickness and encouraged to seek help if needed. Moreover, the students must also be better prepared psychologically before being sent far away from home and thus counselling centres in schools should also be made a priority.

 

ACKNOWLEDGEMENT

We thank the college management for providing us the opportunity and the resources to conduct the study. We thank all the faculty of the Department of Community Medicine, Sree Mookambika Institute of Medical Sciences for their encouragement and guidance. We thank all the first year students who enthusiastically participated in the study.

 

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