Perceived stress, coping strategies, and academic performance among students at a health training institution in Ghana: a cross-sectional study

Background Stress is common in health-professions education, but its association with academic performance may depend on students' psychosocial and educational circumstances. Evidence from Ghanaian health-training institutions remains limited. This study assessed perceived stress, coping strategies, social support, and academic performance among nursing, midwifery, and nurse-assistant students and examined factors independently associated with academic performance. Methods A cross-sectional survey yielded 997 submissions, of which 992 were eligible and included in descriptive analyses. Perceived stress, coping, social support, personality traits, and self-reported academic performance were assessed using adapted questionnaire items. Scale reliability, descriptive and bivariate statistics, multivariable linear regression, and logistic-regression sensitivity analysis were conducted. Linear models used HC3 heteroskedasticity-robust standard errors. Results Among 992 respondents, mean perceived stress was 19.08 (SD 4.03), and 87.9% had moderate stress. Valid cumulative GPA was available for 977 respondents (mean 2.43, SD 0.84), and 58.4% reported a referral or resit. Perceived stress was not independently associated with GPA (B = 0.002, 95% CI -0.011 to 0.015). Adaptive coping was positively associated with GPA (B = 0.184, 95% CI 0.086 to 0.282), whereas maladaptive coping was negatively associated (B=-0.108, 95% CI -0.200 to -0.016). Social support was not independently associated with GPA. In the logistic sensitivity analysis, perceived stress was not associated with referral or resit, whereas adaptive coping was associated with lower odds (OR = 0.64, 95% CI 0.50 to 0.83). Conclusion Moderate perceived stress was common but was not independently associated with either academic outcome. Adaptive and maladaptive coping showed small, opposing associations with GPA. Because the study was cross-sectional and relied on self-reported academic outcomes, the findings do not establish directionality. Prospective multicentre studies using verified academic records and locally validated measures are needed.