Research Article

Incidence of Anemia Among King Abdulaziz University (KAU) Students Suffering from Psychological Disorders

Hussain Faisal Alamri ^1,#, Muath Bandr Alahmdi ^1,#, Abdullah M. Izmirly ^1,2, Ahmed Moustafa M. Al-Kousy ³, and Ibraheem Ashankyty ^1,*

¹ Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box 80216, Jeddah 21589, Saudi Arabia.

² Special Infectious Agents Unit – BSL3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia

³ Department of Psychology, Faculty of Arts, King Abdulaziz University, PO Box 80202 Jeddah 21589, Saudi Arabia

^# Shared first authors

* Correspondence: ishankyty@kau.edu.sa (I.A.)

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Citation: Alamri H.F., Alahamdi M.B., Izmirly A.M., Al-Kousay A.M.M., and Ashankyty, I. Incidence of Anemia Among King Abdulaziz University (KAU) Students Suffering from Psychological Disorders. Glob. Jour. Bas. Sci. 2025, 1(6). 1-10.

Received: March 10, 2024

Revised: April 02, 2025

Accepted: April 09, 2025

Published: April 10, 2025

doi: 10.63454/jbs20000027

ISSN: 3049-3315

Volume 1; Issue 6

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 Abstract: One of the most prevalent public health issues affecting people in low-income and developing nations is anemia. The purpose of this study was to ascertain the prevalence of iron deficiency and anemia among male and female students at King Abdulaziz University (KAU), Saudi Arabia, who appeared to be in good health. Students with psychological illnesses such stress, anxiety, and depression were given special attention. For every psychological state, a suitable sample size of 15–20 students was chosen. To determine the anemia status, hematological and biochemical markers were examined. Just four male participants had anemia (hemoglobin <13.0 g/dL), whereas the rest (95.3%) had normal hemoglobin levels (14.99 ± 1.11 g/dL). In comparison, 67.35% of female students had hemoglobin levels below 12.0 g/dL, indicating a significantly higher prevalence of anemia. Reduced serum ferritin and serum iron levels indicated that 26.54% of anemic female participants had iron-deficiency anemia. Interestingly, despite having normal hemoglobin concentrations, 37.6% of male participants had low mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC), along with elevated red blood cell (RBC) counts, which may indicate the presence of alpha- or beta-thalassemia. Overall, the results show that female students have a high prevalence of anemia, particularly iron-deficiency anemia, whereas a significant percentage of male students may have underlying hemoglobinopathies. Inadequate dietary iron intake and irregular eating habits were found to be possible causes of anemia in the research population. It is advised to carry out extensive research across several King Abdulaziz University faculties in order to provide a more thorough understanding of the kinds, prevalence, and factors of anemia among college students. 

Keywords: Anemia; iron deficiency; students; psychological disorders; King Abdulaziz University

1. Introduction

One of the most prevalent illnesses in humans is anemia. Anemia is thought to affect about one-third of the world’s population. Additionally, iron deficiency is said to be the cause of anemia in 50% of instances. Iron deficiency is as common in the Middle East as it is in underdeveloped nations, with rates ranging from 25% to 35%, as opposed to 5–8% in wealthy nations. Iron deficiency (ID) and iron-deficiency anemia (IDA) are caused by a number of reasons. Any loss of blood results in the body losing iron, which might cause ID. Another characteristic that puts a person at risk for ID is limited intestinal absorption of iron. During their reproductive years, women are more likely to lose iron through nursing, pregnancy, and menstruation. Despite being a poor supply of iron, milk contains enough iron to make nursing moms more likely to get IDA. If children’s elevated iron needs are not satisfied during this time of rapid somatic growth, they may also get IDA[1-6].

One of the most common public health issues in the world, anemia affects people of all ages and socioeconomic backgrounds. It is typified by a decrease in hemoglobin concentration, red blood cell count, or blood’s ability to carry oxygen, which impairs tissue oxygenation. Over two billion people worldwide suffer from anemia, with women of reproductive age, adolescents, and young adults bearing a disproportionately high burden, according to the World Health Organization (WHO). Although iron deficiency is the most common cause of anemia worldwide, its etiology is also significantly influenced by hereditary hemoglobinopathies, chronic inflammation, nutritional inadequacies, and lifestyle variables.

Anemia is a prevalent health concern among university students globally, and King Abdulaziz University (KAU) in Jeddah, Saudi Arabia, is no exception. With a student population exceeding 117,000, anemia poses significant implications for academic performance, physical well-being, and overall student health[1, 5-8]. One distinct and much understudied group at risk for anemia is university students. This population often suffers from low nutritional intake, inconsistent eating patterns, meal skipping, and lifestyle changes brought on by independence and academic pressure. Students may also experience psychological conditions including stress, worry, and depression, which can further affect hormone control, hunger, food absorption, and general physiological health. Many students may have subclinical anemia or iron deficiency that goes misdiagnosed and untreated even though they appear clinically healthy.

While specific data on anemia prevalence among KAU students is limited, studies from Saudi Arabia indicate a high incidence of anemia among university students. A national survey reported that iron deficiency anemia (IDA) is a common condition among healthy young adults from universities across the country. Wiley Online Library At KAU, the student body comprises a significant number of females, who are particularly vulnerable to anemia due to factors such as dietary habits, menstrual blood loss, and insufficient iron intake. This demographic trend underscores the importance of targeted interventions to address anemia among female students[9-17].

It is becoming more widely acknowledged that psychological illnesses play a significant role in physical health issues, such as hematological abnormalities. Erythropoiesis and iron metabolism may be impacted by changes in the hypothalamic-pituitary-adrenal (HPA) axis, inflammatory pathways, and metabolic control that are linked to chronic stress, anxiety, and depression. Stress-related behavioral changes, such as poor diet quality, irregular meals, and lower micronutrient consumption, might worsen the risk of anemia, and elevated inflammatory cytokines can hinder iron absorption and use. However, there is still a lack of research on the connection between anemia and psychological illnesses in young adult populations.

There is ample evidence of sex-based variations in the occurrence of anemia. Due to dietary deficiencies, higher iron requirements, and menstrual blood loss, female students are especially vulnerable. Males, on the other hand, frequently have normal hemoglobin levels but may have underlying red blood cell indices that point to hereditary hemoglobin diseases like beta- or alpha-thalassemia. Due to normal or nearly normal hemoglobin concentrations, thalassemia features are often misdiagnosed or ignored in Middle Eastern countries, particularly Saudi Arabia. When otherwise asymptomatic people exhibit microcytosis, hypochromia, and high red blood cell counts, further study is necessary. Despite advancements in healthcare facilities and dietary knowledge, anemia remains a major public health issue in Saudi Arabia. Anemia prevalence rates among teenagers and young adults, especially among females, have been observed to differ in previous research. However, there is a dearth of evidence that explicitly addresses psychiatric issues in college students. Furthermore, few studies have evaluated iron status biomarkers, hematological indices, and possible genetic markers of anemia in this cohort at the same time.

One of Saudi Arabia’s biggest universities, King Abdulaziz University (KAU), offers a perfect environment for investigating the relationship between anemia and psychological well-being in students from various academic backgrounds. Since untreated anemia can negatively impact cognitive function, academic achievement, immunological function, and general quality of life, it is crucial to understand the prevalence and kinds of anemia in this population. Furthermore, specific preventive and treatment approaches can be informed by identifying modifiable risk factors, such as dietary practices and psychological stressors.

The high incidence of anemia among King Abdulaziz University students is caused by a number of interconnected causes. A major contributing factor is poor eating habits, as many students excessively rely on processed and fast foods with little micronutrient content while consuming insufficient amounts of iron-rich foods like red meat, lentils, and green leafy vegetables. Menstrual blood loss is another important risk factor for female students, especially if dietary iron intake is insufficient to offset the monthly loss, which increases vulnerability to iron-deficiency anemia. Reduced hematological efficiency may result from a sedentary lifestyle, which is more prevalent among college students because of their extended study schedules and lack of physical activity. Furthermore, financial constraints may limit access to nutrient-dense, balanced diets, which can result in long-term inadequacies that put students at risk for anemia. Therefore, socioeconomic considerations must be disregarded. These elements work together to produce a multifactorial risk environment that emphasizes the necessity of thorough dietary and health interventions in academic settings.

Anemia in college students can have profound and wide-ranging effects on their health and academic achievement. Low hemoglobin levels impair the brain’s ability to get oxygen, which can impair cognitive processes including memory, attention, and information processing and reduce learning effectiveness. From a physical health standpoint, anemic students often suffer from exhaustion, generalized weakness, lightheadedness, and decreased endurance, all of which can impede regular daily activities and lower general quality of life. These health issues frequently have an impact on academic performance since low energy and cognitive impairment can lead to low test scores, poor classroom participation, and higher absenteeism. All of these consequences point to anemia as a serious public health issue among students, requiring early detection and focused preventative measures.

In Saudi Arabia, anemia is prevalent. Numerous research, particularly involving children, young women, and women of childbearing age, have been carried out in the nation’s cities. The prevalence of ID and anemia in young males and females in the Jeddah Area, however, remains unknown. The purpose of this study was to ascertain the prevalence of ID and anemia among both male and female King Abdulaziz University students in Saudi Arabia[7, 9, 11-13, 18, 19].

With an emphasis on iron-deficiency anemia and possible hemoglobinopathies, the current study attempts to examine the prevalence of anemia among male and female students at King Abdulaziz University who suffer from psychological illnesses. This study aims to provide important insights into the underlying causes of anemia in university students and to assist the creation of efficient screening and intervention programs within academic institutions by assessing hematological parameters, iron status, and related lifestyle factors.

2. Methods 

2.1. Study Design, Study Population and Sampling: This cross-sectional study was designed to evaluate anemia as a potential risk factor associated with depression among students at King Abdulaziz University (KAU). Data collection was conducted over a period of six weeks to ensure adequate recruitment and comprehensive assessment of participants. Study participants were selected in collaboration with the University Counseling Center under the supervision of Dr. Ahmed Al-Kousy, which facilitated access to students experiencing psychological disorders. The study methodology was developed in alignment with previously published and well-established research protocols in similar populations, and detailed methodological frameworks have been reported in earlier studies [1, 2, 5, 20].

2.2. Inclusion and exclusion criteria: The study population included male and female students aged between 18 and 24 years who were officially enrolled at KAU during the study period and who voluntarily agreed to participate by providing written informed consent. Students were excluded if they had a history of chronic medical conditions such as renal failure, diabetes mellitus, or autoimmune disorders, as these conditions could independently influence hemoglobin levels. In addition, students using medications or supplements known to interfere with hemoglobin concentration, including iron supplements, were excluded. Pregnant students were also excluded due to physiological changes in hematological parameters during pregnancy that could confound the study outcomes.

2.3. Samples and data collection: An adequate and appropriate sample size of approximately 15–20 students was targeted for each category of psychological abnormality, including anxiety, depression, and stress, to ensure meaningful comparative analysis while maintaining feasibility within the study period. This stratified sampling approach allowed for balanced representation of different psychological conditions among the student population and enabled assessment of the association between anemia and specific psychological disorders.

Data collection was carried out using two primary components: a structured questionnaire and laboratory investigations. The structured questionnaire was designed to obtain comprehensive information on participants’ demographic characteristics (age, sex, academic faculty, and year of study), lifestyle factors (dietary habits, physical activity, and meal regularity), and relevant medical history. In addition, standardized and validated psychological assessment tools were incorporated to evaluate the presence and severity of anxiety, depression, and stress among the participants.

The second component of data collection involved laboratory testing to assess hematological and iron status parameters. Venous blood samples were collected from each participant under aseptic conditions by trained medical personnel. The samples were analyzed for complete blood count (CBC), including hemoglobin concentration, red blood cell indices such as mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC). For participants identified as anemic, additional biochemical analyses were performed to evaluate iron status, including serum ferritin and serum iron levels, to differentiate iron-deficiency anemia from other possible causes.

All data were collected following standard operating procedures to ensure accuracy, reliability, and reproducibility. Participants’ confidentiality was strictly maintained, and all collected data were anonymized prior to analysis.

2.4. Complete Blood Count (CBC):

Complete blood count (CBC) analysis was performed to evaluate the hematological status of the study participants and to identify the presence and type of anemia. The CBC parameters measured included red blood cell count (RBC, ×10¹²/L), hemoglobin concentration (Hb, g/dL), hematocrit (Hct, %), mean corpuscular volume (MCV, fL), mean corpuscular hemoglobin (MCH, pg), mean corpuscular hemoglobin concentration (MCHC, g/dL), and red blood cell distribution width (RDW), expressed as both coefficient of variation (RDW-CV) and standard deviation (RDW-SD). These parameters provide comprehensive information on red blood cell morphology, size variation, and hemoglobin content, which are essential for distinguishing between different types of anemia.

All hematological measurements were conducted using a Sysmex XN–1000 automated hematology analyzer (Sysmex Corporation, Japan), which is based on advanced fluorescence flow cytometry and impedance technology, ensuring high precision, accuracy, and reproducibility of results. Serum ferritin levels, an important indicator of body iron stores, were measured using a Maglumi 600 chemiluminescence immunoassay system (Snibe, China). Serum iron concentrations were determined using a HumaStar 200 fully automated clinical chemistry analyzer (Human Diagnostics, Germany), following the manufacturer’s protocols.

The materials and equipment used in this study included the Sysmex XN series hematology analyzer (XN-9000/XN-1000) for CBC analysis, sterile phlebotomy supplies such as disposable needles, syringes, vacutainers, and appropriate blood collection tubes, as well as personal protective equipment (PPE), including laboratory coats, gloves, and face masks, to ensure biosafety during sample collection and processing.

Blood samples were collected at King Abdulaziz University Hospital by trained and experienced phlebotomists under strict aseptic conditions. Venous blood was drawn from each participant and immediately transferred to ethylenediaminetetraacetic acid (EDTA) tubes for CBC analysis and plain tubes for serum separation. Following collection, the samples were transported promptly to the Hematology Laboratory for analysis using the automated hematology analyzer.

The primary hematological parameters assessed included hemoglobin concentration, red blood cell count, hematocrit, mean corpuscular volume, and mean corpuscular hemoglobin. These indices were used to classify anemia based on red blood cell size and hemoglobin content, enabling differentiation between microcytic, normocytic, and macrocytic anemia.

Anemia was defined in accordance with the World Health Organization (WHO) criteria, wherein hemoglobin concentrations below 13.0 g/dL in men and below 12.0 g/dL in women were considered indicative of anemia. This standardized definition ensured consistency and comparability of the findings with existing epidemiological studies.

2.6. Questionnaire: A structured, self-administered questionnaire was used to collect comprehensive demographic, health-related, and psychological information from the study participants. The demographic section included data on age, gender, academic year, and marital status, allowing characterization of the study population. The health history section captured self-reported information on prior diagnosis of anemia or related conditions, providing contextual background for the hematological findings.

Assessment of psychological status was performed using validated screening instruments. Depressive symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9), a widely accepted and reliable tool for measuring the severity of depression in both clinical and non-clinical populations. Based on the total PHQ-9 score, depression severity was categorized as minimal (0–4), mild (5–9), moderate (10–14), moderately severe (15–19), or severe (20–27). Anxiety symptoms were assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale, a validated instrument for screening and grading anxiety severity. According to GAD-7 scores, anxiety levels were classified as minimal (0–4), mild (5–9), moderate (10–14), or severe (15–21). Together, these standardized tools ensured reliable evaluation of psychological disorders and facilitated analysis of their association with anemia among KAU students.

3. Results

3.1. Fundamental parameter analysis: A Sysmex XN–1000 Hematology Analyzer (Japan) was used to determine the CBC including red blood cells (RBC, x1012/L), hemoglobin (Hb, g/dL), hematocrit (Hct, %), mean cell volume (MCV, fL), mean cell hemoglobin (MCH, pg), mean cell hemoglobin concentration (MCHC, g/dL), and red blood cell distribution width (RDW-CV and SD). A chemiluminescence Immunoassay system (China) using Maglumi 600 was used for the determination of serum ferritin. Serum iron was tested with a HumaStar 200 (Germany) chemistry   analyzer.

3.2. Demographic characteristics: Students from a diverse range of academic faculties at King Abdulaziz University participated in the study, including the faculties of Business, Engineering, Information Technology, Law, and Sciences. This multidisciplinary representation allowed for a broader assessment of anemia and psychological disorders across different educational backgrounds and academic demands. The  majority of participants were in their early  twenties, reflecting the typical age distribution of undergraduate students; however, the overall age of the study population ranged from 18 to 28 years. Students from various academic levels were included, spanning from the preparatory year through the fifth academic year. Inclusion of students at different stages of their academic progression enabled evaluation of potential variations in anemia prevalence and psychological stress related to academic workload, progression, and transitional phases within university life.

3.3. Psychological disorders: Psychological assessment of the study participants was conducted using two widely validated and internationally accepted self-report instruments: the Patient Health Questionnaire-9 (PHQ-9) for the evaluation of depressive symptoms and the Generalized Anxiety Disorder-7 (GAD-7) questionnaire for the assessment of anxiety symptoms (Figure 1). These tools were selected due to their strong psychometric properties, ease of administration, and proven reliability in both clinical and non-clinical populations, including university students.

The PHQ-9 questionnaire consists of nine items that assess the frequency of depressive symptoms experienced over the previous two weeks. Each item is scored on a four-point Likert scale ranging from 0 (“not at all”) to 3 (“nearly every day”), yielding a total score between 0 and 27. Based on established cutoff values, participants were classified into categories representing minimal, mild, moderate, moderately severe, or severe depression. Analysis of PHQ-9 scores revealed that a substantial proportion of students exhibited depressive symptoms, with approximately 50% of the   participants falling within the mild to moderate depression categories (Figure 2). This finding highlights a considerable burden of depressive symptomatology among KAU students, which may have important implications for both mental health and physiological outcomes such as anemia.

     

Figure 1. Depression rate.                                             Figure 2. Depression percentage.

Anxiety symptoms were assessed using the GAD-7 questionnaire, which includes seven items designed to evaluate the severity of generalized anxiety symptoms over the past two weeks. Similar   to the PHQ-9, responses are scored on a four-point scale (0–3), producing a total score ranging from 0 to 21. Participants were categorized into minimal, mild, moderate, or severe anxiety based on their total scores. The results demonstrated a notable prevalence of anxiety symptoms among the study population. Approximately 30% of students reported anxiety levels within the moderate to severe range (Figures 3 and 4), indicating a significant psychological burden within this cohort.

                           

                           Figure 3. Anxiety (GAD-7) rate.                                                                                              Figure 4. Anxiety percentage.

Overall, the findings from the PHQ-9 and GAD-7 assessments underscore the high prevalence of depressive and anxiety symptoms among KAU students. These psychological stressors may play a contributory role in the development or exacerbation of anemia through mechanisms such as altered dietary habits, hormonal imbalance, and chronic stress-related inflammation. The integration of psychological assessment with hematological parameters in this study provides a more comprehensive understanding of the interplay between mental health and anemia in the university student population.

3.4. Incidence of anemia: The incidence of anemia was found to be relatively high among students diagnosed with psychological disorders, indicating a potential association between mental health status and hematological abnormalities. Approximately 25% of students who screened positive for depression or anxiety were also diagnosed with anemia based on hemoglobin and related hematological indices. This proportion is notably higher than what is typically observed in the general young adult population, suggesting that students experiencing psychological distress may be at increased risk of developing anemia.

A closer examination of symptom severity revealed that the coexistence of anemia was more pronounced among students with moderate to severe levels of depression and anxiety. These students demonstrated lower hemoglobin concentrations and, in several cases, altered red blood cell indices consistent with iron deficiency or other underlying hematological conditions. The observed trend suggests a dose–response relationship, whereby increasing severity of psychological symptoms is associated with a higher likelihood of anemia.

Several biological and behavioral mechanisms may underlie this association. Chronic psychological stress and mood disorders are known to influence dietary intake, appetite regulation, and nutrient absorption, potentially leading to inadequate iron consumption or utilization. In addition, prolonged stress can activate inflammatory pathways and alter hormonal regulation, which may impair erythropoiesis and iron metabolism. Behavioral factors such as irregular meal patterns, poor diet quality, and reduced health-seeking behavior among students with depression or anxiety may further exacerbate the risk of anemia.

Although the cross-sectional design of the study does not allow for causal inference, the findings strongly suggest a meaningful link between psychological disorders and anemia in the student population. These results emphasize the importance of integrated screening approaches that simultaneously address mental health and nutritional or hematological status. Early identification and management of both psychological disorders and anemia may improve overall health outcomes, academic performance, and quality of life among university students.

3.5. Impact on everyday living: Students who were affected by both a psychological disorder and anemia reported a substantially greater negative impact on their daily functioning compared with students who had either condition alone. The combined presence of mental health symptoms and reduced hemoglobin levels appeared to have a synergistic effect, intensifying physical, cognitive, and emotional challenges. Many of these students described persistent fatigue, lack of motivation, difficulty concentrating, and reduced stamina, all of which directly interfered with their academic responsibilities. Tasks such as attending lectures, completing assignments, preparing for examinations, and maintaining consistent study schedules were reported as particularly challenging, often resulting in declining academic performance and increased absenteeism.

Beyond academics, students also experienced notable disruptions in their social lives. Feelings of exhaustion, low mood, irritability, and anxiety, compounded by the physical weakness associated with anemia, led many students to withdraw from social interactions and extracurricular activities. This social isolation further contributed to emotional distress, creating a cycle in which psychological symptoms and physical ill-health reinforced one another. Overall well-being was markedly compromised, with students reporting reduced quality of life, diminished self-confidence, and difficulties in managing routine daily activities.

The level of support received by these students varied considerably. Some students had access to comprehensive care, including psychological counseling, pharmacological treatment for depression or anxiety, and medical management of anemia through iron supplementation or dietary advice. Others received only partial support, such as occasional consultations without consistent follow-up or treatment adherence. A subset of students reported receiving minimal or no professional support at all, relying instead on self-management strategies or peer support. These disparities highlight gaps in awareness, accessibility, and integration of healthcare services for students facing coexisting psychological and hematological conditions. The findings underscore the need for coordinated, multidisciplinary intervention strategies within university health systems to address both mental health and anemia simultaneously, thereby improving academic success, social functioning, and overall student well-being.

4. Dicussion: This study investigated the association between anemia and psychiatric disorders among students at King Abdulaziz University (KAU), with a particular focus on anxiety and depression. The findings revealed a notably high prevalence of psychological disorders within the student population, with anxiety and depressive symptoms emerging as the most common mental health concerns. Importantly, a substantial proportion of students who were diagnosed with psychological disorders also exhibited clinical indicators of anemia, suggesting a meaningful overlap between these two conditions. Collectively, these observations support the possibility of a significant relationship between anemia and mental health disorders among university students.

The observed prevalence of anemia, estimated at approximately 25% among students with psychological disorders, is consistent with previously published studies that have highlighted strong links between nutritional deficiencies and mental health outcomes. Iron-deficiency anemia, the most prevalent form of anemia worldwide, has been extensively associated with alterations in mood, reduced energy levels, impaired cognitive function, and diminished attention span—factors that are closely intertwined with the pathophysiology of anxiety and depression. In this context, the study population illustrates a bidirectional relationship between anemia and poor mental health. Psychological stress and emotional disturbances may contribute to irregular eating habits, poor dietary choices, and inadequate iron intake, thereby increasing the risk of developing anemia. Conversely, anemia-related symptoms such as chronic fatigue, lethargy, and difficulty concentrating may exacerbate existing psychological symptoms, further worsening mental health status.

These findings underscore a vicious cycle in which mental health disorders and anemia reinforce one another, leading to a compounded negative effect on students’ overall well-being and academic functioning. The results align with earlier evidence demonstrating that nutritional status plays a critical role in mental health and that addressing underlying hematological deficiencies may be an important component of comprehensive mental health care. Taken together, the study emphasizes the importance of integrated screening and intervention strategies that simultaneously address both psychological health and nutritional status in university student populations.

Anemia, particularly iron-deficiency anemia (IDA), remains one of the most common nutritional disorders worldwide and continues to pose a significant public health concern, especially among women and young adults. Within the context of King Abdulaziz University (KAU), the burden of anemia among students—most notably female students—represents a complex, multifactorial issue influenced by an interplay of biological, behavioral, and environmental factors [12, 20, 24]. This complexity underscores the need for focused research within university populations, where both nutritional vulnerability and psychosocial stressors frequently coexist.

Multiple studies conducted at KAU and other Saudi universities have reported alarmingly high rates of anemia among female students. Some investigations have indicated that nearly half of university-aged women may be anemic, with a considerable proportion exhibiting moderate forms of anemia. These findings are consistent with global epidemiological data, which consistently demonstrate that women of reproductive age are at increased risk due to regular menstrual blood loss, higher iron requirements, and often insufficient dietary iron intake. Inadequate consumption of iron-rich foods, coupled with poor iron bioavailability in commonly consumed diets, further contributes to this heightened susceptibility.

At KAU, where a large and diverse student population is enrolled across multiple academic disciplines, additional lifestyle-related factors may intensify the risk of anemia. Academic demands, examination stress, irregular class schedules, and reliance on fast or processed foods can negatively affect dietary quality and meal regularity. Female students, in particular, may face compounded risks—not only because of physiological factors but also due to social and cultural influences that shape eating behaviors, health awareness, and healthcare-seeking practices. Limited attention to preventive health measures, delayed diagnosis, and underutilization of nutritional counseling services may further contribute to the persistence of anemia within this population.

Together, these observations highlight anemia among KAU students as a significant and underrecognized health issue with potential implications for physical health, cognitive performance, and academic success. Addressing this problem requires a comprehensive approach that integrates nutritional education, routine screening, and targeted interventions, particularly for high-risk groups such as female students.

Multiple interrelated causes contribute to the high incidence of anemia among KAU students:

• Nutritional Deficiencies: Many students, especially those living away from home, may rely on convenience foods that are high in calories but low in micronutrients. A diet lacking in iron-rich foods such as red meat, leafy greens, and legumes contributes significantly to the development of anemia.
• Menstrual Blood Loss: Heavy or prolonged menstrual cycles are a leading contributor to iron loss in young women. Without adequate compensation through diet or supplementation, this can lead to chronic anemia.
• Lack of Health Awareness: Despite being in an academic setting, many students may not fully understand the symptoms of anemia or the importance of regular check-ups. Cultural taboos surrounding menstruation and female health can further inhibit discussions and early interventions.
• Socioeconomic Status: Students from lower-income families may have limited access to nutritious food and medical care. Economic constraints often force compromises in diet quality and frequency of health consultations.
• Lifestyle and Stress: The sedentary lifestyle and academic pressures faced by university students can also indirectly affect iron metabolism. Chronic stress impacts the gastrointestinal system, possibly impairing nutrient absorption.

Anemia has profound consequences on both physical and cognitive function. The classic symptoms—fatigue, paleness, dizziness, shortness of breath—are often accompanied by cognitive impairments, such as reduced attention span, memory issues, and slower reaction times. These effects can be particularly detrimental in an academic environment, where mental performance is constantly tested[10, 16].

Several students at KAU have reported decreased productivity, increased absenteeism, and feelings of being overwhelmed—symptoms that are often mistakenly attributed solely to academic burnout. When undiagnosed anemia is the underlying issue, students may be trapped in a cycle of poor health and poor performance[1, 25].

Although KAU provides access to campus health services, gaps remain in terms of preventive screening, nutritional guidance, and student engagement in health initiatives. Few structured programs actively address anemia prevention. The absence of mandatory nutritional counseling and lack of collaboration between health centers and student affairs exacerbate the invisibility of the issue.

Moreover, anemia often goes unnoticed in otherwise “healthy-looking” students. This underdiagnosis delays treatment and allows for long-term complications such as chronic fatigue, compromised immunity, and, in extreme cases, heart strain.

To effectively combat the high incidence of anemia among KAU students, the following multidimensional strategies are recommended:

1. Mandatory Screening: Introduce regular, university-wide screening for anemia, particularly targeting first-year students and female students.
2. Nutritional Education Campaigns: Launch awareness programs on the importance of iron in the diet, identifying iron-rich foods, and combating myths around food restrictions.
3. On-campus Nutrition Services: Provide subsidized access to iron-rich meals and dietary consultations within campus cafeterias and clinics.
4. Interdisciplinary Collaboration: Encourage partnerships between the university’s medical faculty, nutrition departments, and student affairs to promote holistic student wellness.
5. Psychological Support: Integrate mental health services with physical health programs, recognizing the role of stress and emotional well-being in nutritional health.
6. Research and Monitoring: Support ongoing research to continuously assess anemia prevalence, identify emerging trends, and monitor the effectiveness of interventions.

According to Jacka et al.[21], teenagers who consume a lot of processed meals and little iron-rich food are far more prone to experience psychological discomfort. They proposed that mental health conditions like anxiety and depression may be directly caused by inadequacies in food intake, particularly iron. This supports the assertions that these results offer convincing proof of the importance of food quality as a changeable component of students’ mental health. Furthermore, the results showed that pupils who experienced moderate to severe anxiety and sadness were also more likely to be labeled anemic. This confirms earlier research[20] that found a correlation between a student’s likelihood of being anemic and the severity of their psychological symptoms. According to their research, iron deficiency anemia increases the risk of emotional disorders, irritability, exhaustion, and subpar academic performance in addition to impairing cognitive function. Berger & Dillon came to the conclusion that co-occurring psychological symptoms and anemia should be taken into account since they frequently result in compounding negative effects. Intervention and early detection are critical[8, 17, 22, 26, 27].

Iron deficiency, even in the absence of anemia, has quantifiable impacts on neurotransmitter modulation and brain energy expenditure, according to Beard et al., which supports the findings[3]. According to Beard et al., those who are iron deficient may have slower processing speeds and altered emotional behaviors, which increases their risk of developing anxious and depressive symptoms. In a similar vein, McLean et al. discovered a strong correlation between psychological discomfort and iron deficiency anemia in women of reproductive age[6].

Previous studies added encouraging regional data to the body of research by studying Saudi university students and discovering a significant link between a higher incidence of depression symptoms and poor dietary iron intake[1, 5, 22]. The findings were linked to the local cultural setting and corresponding eating practices, however the authors acknowledged a correlation with site-specific data. According to the third article, Brunner et al.[28] investigated teenagers in Switzerland and discovered that psychological stress has a known impact on iron metabolism through inflammation. Inflammatory indicators, such as interleukin-6, may rise in people who are under ongoing stress. Hepcidin, which can prevent iron absorption and availability, will rise in tandem with the general increase in inflammation, creating a physiologic link between iron shortage and stress.

It’s interesting to note that students in this study offered a range of assistance in managing their physical and mental health, indicating that the university healthcare system for students needs to be improved. Given that college students are a particularly high-risk demographic, this emphasizes the need for integrated health programs that address mental and physical health in a complementary manner.

The researchers acknowledge a number of limitations, despite the fact that the work offers valuable information. The study’s cross-sectional design is its primary drawback, since it restricts the ability to demonstrate causal links between anemia and psychological illnesses in the sample group over time. The study’s relatively small sample size is another drawback, which has an immediate influence on the study’s capacity to generalize its findings about the impact on health. Longitudinal follow-up data gathering and broader, more varied data sampling in future studies would support the findings of this one and offer proof of the possible efficacy of interventions. Anemia among students at King Abdulaziz University is more than a medical condition—it is a reflection of deeper systemic, behavioral, and social challenges. The high prevalence rates necessitate immediate and sustained action by university authorities, healthcare professionals, and the students themselves. Through early detection, education, and access to appropriate care, KAU can set a model for other institutions in Saudi Arabia and the region in improving student health and academic success.

5. Conclusions: According to this study, anemia and psychiatric illnesses are significantly correlated among KAU students. According to this study, students who have psychological issues should get regular anemia screenings, and vice versa. Ensuring students’ general physical and emotional well-being may include offering holistic health services, stress management classes, and dietary education on campus.

The high incidence of anemia among students at King Abdulaziz University (KAU), particularly among female students, reflects a broader public health concern that intertwines nutritional deficiencies, lifestyle behaviors, and socio-demographic factors. Despite being an academic institution with access to medical knowledge and healthcare resources, the prevalence of anemia within this student population underscores a critical gap between awareness and action. 

Iron-deficiency anemia, the most common form observed at KAU, is not merely a clinical diagnosis—it is a condition that directly impacts students’ academic performance, psychological well-being, and physical health. Symptoms such as fatigue, poor concentration, and impaired physical stamina can significantly diminish students’ educational engagement, productivity, and quality of life. More concerning is the fact that many students may remain undiagnosed, attributing these symptoms to academic stress or general tiredness, thereby delaying intervention. The underlying causes identified—ranging from poor dietary habits and insufficient iron intake to menstrual blood loss and sedentary lifestyles—call for a multi-level strategy that goes beyond traditional health education. KAU and similar institutions must adopt a proactive role in addressing anemia through a combination of policy implementation, health promotion, and individualized care.

This includes:

• Nutritional awareness campaigns that emphasize iron-rich diets and dispel myths around food choices.
• Routine anemia screening programs, especially targeting at-risk groups such as female students.
• Collaboration between academic departments and health services to integrate health education into the broader university curriculum.
• Psychosocial support services that recognize the intersection between health and academic stressors.
• Access to affordable iron supplements and nutritional counseling on campus.

Ultimately, tackling anemia at KAU is not only a health imperative but also a developmental priority. A healthier student body fosters better academic performance, enhances personal development, and contributes to the university’s broader mission of societal advancement. Long-term change will require sustained commitment from institutional leadership, faculty, and students themselves to create a campus culture where well-being is not just an ideal but a practiced reality.

Author Contributions: Conceptualization, H.F.A., M.B.A., A.M.I., A.M.M.A., and I.A.; methodology, H.F.A., M.B.A., A.M.I., A.M.M.A., and I.A.; software, I.A.; validation, H.F.A., M.B.A., A.M.I., A.M.M.A., and I.A.; formal analysis, H.F.A., M.B.A., A.M.I., A.M.M.A., and I.A.; investigation, H.F.A., M.B.A., A.M.I., A.M.M.A., and I.A.; resources, H.F.A., M.B.A., A.M.I., A.M.M.A., and I.A.; data curation, R.Q. and M.M.; writing—original draft preparation, R.Q., P.K.S., and M.M.; writing—review and editing, R.Q., P.K.S., and M.M.; visualization, H.F.A., M.B.A., A.M.I., A.M.M.A., and I.A.; supervision, I.A.; project administration, I.A.; funding acquisition, I.A. The authors have read and agreed to the published version of the manuscript.

Funding: Not applicable.

Acknowledgments: We are grateful to the Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia, Special Infectious Agents Unit – BSL3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia, and Department of Psychology, Faculty of Arts, King Abdulaziz University, PO Box 80202 Jeddah 21589, Saudi Arabia for providing us all the facilities to carry out the entire work.

Conflicts of Interest: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Institutional Review Board Statement: Not applicable.

Informed Consent Statement: A signed participant informed consent was obtained from every participant before enrollment in the study. Confidentiality will be assured by permitting anonymity data storage. The information is only accessible to authorized research team personnel.

Data Availability Statement: All the related data are supplied in this work or have been referenced properly.

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