academic stress and mental health thesis

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Academic Stress and Mental Well-Being in College Students: Correlations, Affected Groups, and COVID-19

Affiliations.

1 Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, United States.
2 Rutgers New Jersey Medical School, Newark, NJ, United States.
3 Office for Diversity and Community Engagement, Rutgers New Jersey Medical School, Newark, NJ, United States.
4 Department of Biology, The College of New Jersey, Ewing, NJ, United States.
PMID: 35677139
PMCID: PMC9169886
DOI: 10.3389/fpsyg.2022.886344

Academic stress may be the single most dominant stress factor that affects the mental well-being of college students. Some groups of students may experience more stress than others, and the coronavirus disease 19 (COVID-19) pandemic could further complicate the stress response. We surveyed 843 college students and evaluated whether academic stress levels affected their mental health, and if so, whether there were specific vulnerable groups by gender, race/ethnicity, year of study, and reaction to the pandemic. Using a combination of scores from the Perception of Academic Stress Scale (PAS) and the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS), we found a significant correlation between worse academic stress and poor mental well-being in all the students, who also reported an exacerbation of stress in response to the pandemic. In addition, SWEMWBS scores revealed the lowest mental health and highest academic stress in non-binary individuals, and the opposite trend was observed for both the measures in men. Furthermore, women and non-binary students reported higher academic stress than men, as indicated by PAS scores. The same pattern held as a reaction to COVID-19-related stress. PAS scores and responses to the pandemic varied by the year of study, but no obvious patterns emerged. These results indicate that academic stress in college is significantly correlated to psychological well-being in the students who responded to this survey. In addition, some groups of college students are more affected by stress than others, and additional resources and support should be provided to them.

Keywords: COVID-19; Perception of Academic Stress; Short Warwick-Edinburgh Mental Well-Being Scale; academic stress; college students; well-being.

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academic stress and mental health thesis

Mental health in young adults (18-30): The role of motivation, academic stress and coping strategies

Garnefski, N. Kraaij, V.

Assessment of academic stress and its coping mechanisms among medical undergraduate students in a large Midwestern university

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Published: 27 July 2020
Volume 40 , pages 2599–2609, ( 2021 )

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Nitin Joseph ORCID: orcid.org/0000-0002-3639-510X 1 , 2 ,
Aneesha Nallapati 2 , 3 ,
Mitchelle Xavier Machado 2 , 3 ,
Varsha Nair 2 , 3 ,
Shreya Matele 2 , 3 ,
Navya Muthusamy 2 , 3 &
Aditi Sinha 2 , 3

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Academic stress is the most common mental state that medical students experience during their training period. To assess academic stress, to find out its determinants, to assess other sources of stress and to explore the various coping styles against academic stress adopted by students. Methods: It was a cross sectional study done among medical students from first to fourth year. Standard self-administered questionnaires were used to assess academic stress and coping behaviour. Mean age of the 400 participants was 20.3 ± 1.5 years. 166(41.5%) of them were males. The academic stress was found to be of mild, moderate and severe level among 68(17%), 309(77.3%) and 23(5.7%) participants respectively. Overall coping with stress was found to be poor, average and good among 15(3.8%), 380(95%) and 5(1.2%) participants respectively. Passive emotional ( p = 0.054) and passive problem ( p = 0.001) coping behaviours were significantly better among males. Active problem coping behaviour ( p = 0.007) was significantly better among females. Active emotional coping behaviour did not vary significantly between genders ( p = 0.54). Majority of the students preferred sharing their personal problems with parents 211(52.7%) followed by friends 202(50.5%). Binary logistic regression analysis found worrying about future ( p = 0.023) and poor self-esteem ( p = 0.026) to be independently associated with academic stress. Academic stress although a common finding among students, the coping style to deal with it, was good only in a few. The coping behaviours were not satisfactory particularly among male participants. This along with other determinants of academic stress identified in this study need to be addressed during counselling sessions.

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Introduction

Academic stress has been reported to be the most common mental state that medical students experience during their training period (Ramli et al. 2018 ). It is on the rise among them probably due to increasing course requirements (Ramli et al. 2018 ; Drolet and Rodgers 2010 ). Kumaraswamy ( 2013 ) observed that the issues known to precipitate academic stress were excessive assignments, peer competition, examinations and problems related to time management. University students, for the life phase they are going through, also have to deal with many other stresses such as detachment from the family, building of self-identity and issues concerning adolescence period and those in relation to student-workers. The stress of the medical student is also connected to the relationship with the patient in the clinical period.

Some amount of academic stress is beneficial as it brings about healthy competition with peer group, promotes learning and helps to excel in academics (Malathi and Damodaran 1999 ; Afolayan et al. 2013 ). Lumley and Provenzano ( 2003 ) however reported that, excess of academic stress adversely affects academic performance, class attendance and psychological well-being of students. If it is not identified early and managed, it can cause depression, anxiety, behavioural problems, irritability, social withdrawal and physical illnesses (Adiele et al. 2018 ; Deb et al. 2015 ; Verma et al. 2002 ; Chen et al. 2013 ).

In addition to assessment of academic stress among under graduate medical students, it is also essential to analyze the various stress coping mechanisms adopted by them. This will help researchers in suggesting appropriate intervention strategies for the benefit of the students. Students in turn can educate their patients in future to identify stress and suggest measures to deal with it.

Previous studies have reported that medical students used active coping mechanisms (Al-Dubai et al. 2011 ; Chawla and Sachdeva 2018 ; Gade et al. 2014 ; Abouammoh et al. 2020 ), positive reframing (Al-Dubai et al. 2011 ; Chawla and Sachdeva 2018 ), planning (Chawla and Sachdeva 2018 ; Wu et al. 2018 ), positive reappraisal (Wu et al. 2018 ), emotional support (Chawla and Sachdeva 2018 ; Gade et al. 2014 ), peer discussions (Oku et al. 2015 ) and acceptance (Al-Dubai et al. 2011 ; Chawla and Sachdeva 2018 ) as means for coping stress. There were minimal reports of usage of avoidance strategies for coping stress among medical students (Al-Dubai et al. 2011 ; Chawla and Sachdeva 2018 ).

Royal College of Psychiatrists ( 2011 ) reported that students with secure attachments to family and those residing in a supportive community are in a better position to handle stress. Therefore assessment of various determinants of academic stress is essential to frame most suitable remedial measures for the benefit of the affected. This study was hence done to assess academic stress, to find out its determinants, to assess other sources of stress and to explore the various coping styles adopted by medical students to deal with academic stress in a coastal city in south India.

Materials and Methods

This cross sectional study was conducted in the month of March 2018 at a private medical college in Mangalore. The institutional ethics committee approval was taken before the commencement of the study. Permission to conduct the study was taken from the Dean. Sample size of 364 participants was calculated at 95% confidence intervals (CI), 90% power and the proportion of medical students with average level of academic stress taken as 51.4% based on the findings of Mostafavian et al. ( 2018 ). A non-response rate of 10% was added to arrive at the final sample size which was calculated as 400 participants. A total of 100 students of Bachelor of Medicine and Bachelor of Surgery course from first year to fourth year were therefore chosen to participate in this study using simple random sampling method.

The students were briefed about academic stress and the objectives of this study, in the classroom setting, and written informed consent was taken for their participation. In order to maintain anonymity, the filled in consent form were first collected back from the participants. Later the questionnaires were distributed by the investigators. It was a semi-structured questionnaire containing both closed and open ended questions. It was pre-tested in a group of ten students before its use in the current study. No changes in the questionnaire resulted following the pre-testing and the data collected in this phase were not included in the final study.

Data Collection Tools

Academic stress was assessed using the academic stress inventory tool for university students prepared by Lin and Chen ( 2009 ). They had reported the alpha value of Cronbach’s reliability test for this questionnaire as 0.90. The questionnaire was slightly modified during the content validation phase in this study to incorporate questions on career related issues along with few other minor changes. This questionnaire contained 35 items which were designed in a five point Likert scale. The responses in the scale were “completely disagree,” “disagree,” “neutral,” “agree,” and “completely agree”, with scores ranging from one to five points respectively. Cumulative scores ranging from 35 to 81, 82 to 128 and 129 to 175 were considered as mild, moderate and severe levels of academic stress respectively.

The coping techniques employed by the respondents was assessed using the academic stress coping style inventory developed by Lin and Chen ( 2010 ). The Cronbach’s alpha value of internal consistency for the stress coping style questionnaires was reported by them to be 0.83. It was shortened during the content validation phase to result in 25 questions designed again in Likert’s five-point scale. Scores were ranging from 5 for “completely agree” to 1 for “completely disagree”. Overall coping with stress was rated as poorly adoptive when cumulative score of the participant ranged from 25 to 58, average when it was 59 to 92 and good when it was 93 to 125.

Coping behaviour were grouped as active emotional coping, active problem coping, passive emotional coping and passive problem coping behaviours. Active emotional coping behaviour involved individuals adopting the attitude of emotional adjustment like positive thinking emotions and self-encouragement, when faced with academic stress. Active problem coping behaviour involved dealing academic stress by focussing at the centre of the problem and finding a solution themselves by being calm and optimistic or by searching assistance from external sources. Passive emotional coping behaviour involved constraining emotions, self-accusation, getting angry, blaming others or God or by giving up. Passive problem coping behaviour involved procrastinations, evasive behaviours or going into alcohol or drug abuse while facing academic stress (Lin and Chen 2010 ).

The overall alpha value of Cronbach’s reliability test for the academic stress and coping style inventory questionnaire used in this study was calculated to be 0.901, indicating excellent reliability.

Statistical Analysis

The data entry and analysis were done using IBM SPSS for Windows version 25.0, Armonk, New York. Statistical tests like Chi square test, Fisher’s exact test, Student’s unpaired t test and Karl Pearson’s coefficient of correlation were used for analysis. All the determinants of academic stress significant at 0.15 level were placed in the multivariable model. Backward stepwise elimination procedure was done to identify the independent determinants of academic stress in the model at the last step. p value 0.05 or less was used as the criterion for significance.

A total of 400 students participated in this study and all of them gave satisfactorily filled forms. Their mean age was 20.3 ± 1.5 years and median age was 20 years with an Inter Quartile Range (19, 22) years. As many as 166(41.5%) of them were males. Out of the total participants, 45(11.2%) were local residents, 51(12.8%) were outsiders but within the same state, 262(65.5%) were from other states within India, 35(8.8%) were non-residential Indians and the rest 7(1.7%) were foreigners. Medium of schooling among 388(97%) students was English.

Among the participants, 67(16.7%) were currently staying at their home or rented apartment while the rest 333(83.3%) were staying in the hostels or were staying as paying guests. Majority of them [228(57%)] were staying with their friends. Among others, 118(29.5%) were staying alone, 46(11.5%) with their parents, 7(1.8%) with their relatives and one with her elder sibling.

With respect to lifestyle habits, majority of the participants [249(62.2%)] went to college by walk, and majority [339(84.7%)] slept for 6 to 8 h on an average per day. (Table 1 ).

Sources of Stress among Participants

Majority of students either agreed or strongly agreed that some teachers provided so much of academic information, making it difficult for students to assimilate knowledge [177(44.2%)]. Fear of failure in the exams was the other major cause of academic stress [206(51.5%)]. (Table 2 ).

Majority of students either agreed or strongly agreed that by missing few lectures, they felt anxious about falling short of attendance towards the end [204(51%)]. They also regretted having wasted time set apart for studies [240(60%)]. (Table 3 ).

Overall the level of academic stress was found to be mild among 68(17%), moderate among 309(77.3%) and severe among 23(5.7%) participants. The mean academic stress score was found to be 100.6 ± 19.7. Gender wise variation in academic stress levels was noticed. It was of mild, moderate and severe level among 29(17.5%), 129(77.7%) and 8(4.8%) males and among 39(16.7%), 180(76.9%) and 15(6.4%) females respectively (X 2 = 0.472, p = 0.79).

The other non-academic sources of stress reported by participants were lack of sufficient vacations [130(32.5%)], staying away from family [103(25.7%)], worrying about future [70(17.5%)], low self-esteem [52(13%)], having trouble with friends 39(9.7%)], facing financial difficulties [33(8.2%)], interpersonal conflicts [28(16.7%)], conflicts with roommates [26(6.5%)], issues with partners [23(5.8%)], sleeping disorders [21(5.2%)], transportation problems [20(5%)], problems in the family [18(4.5%)], searching a partner [17(4.2%)] and lack of parental support [5(1.2%)].

14(3.5%) participants had underlying chronic morbidities. These morbidities were allergic rhinitis among 3, migraine among 3, polycystic ovarian disease among 3, menorrhagia among 2 and allergy, peptic ulcer, hypothyroidism, and impaired glucose tolerance in one student each.

Coping Strategies Adopted by Participants

Majority of the participants [294(73.5%)] either agreed or strongly agreed that they tried to think or do something, that would make them feel happier and relaxed when they were stressed. (Table 4 ).

Overall coping with stress was found to be poor among 15(3.8%), average among 380(95%) and good among 5(1.2%) participants.

The mean coping with stress score was 75.2 ± 9.2. The mean score of various coping behaviours like active emotional coping (items 1 to 6), active problem coping (items 14 to 18), passive emotional coping (items 7 to 13) and passive problem coping (items 19 to 25) were found to be 21.7 ± 3.4, 13.2 ± 2.7, 18.6 ± 4.6 and 18.3 ± 4.2 respectively. (Table 4 ).

Mean active emotional coping score among males ( n = 166) was 21.5 ± 3.5 and among females ( n = 234) was 21.8 ± 3.3 (t = 0.613, p = 0.54). Mean passive emotional coping score among males (n = 166) was 19.1 ± 5.0 and among females (n = 234) was 18.2 ± 4.1 (t = 1.933, p = 0.054). Mean active problem coping score among males (n = 166) was 12.8 ± 2.8 and among females (n = 234) was 13.5 ± 2.5 (t = 2.711, p = 0.007). Mean passive problem coping score among males (n = 166) was 19.1 ± 4.4 and among females (n = 234) was 17.7 ± 3.9 (t = 3.412, p = 0.001).

The various measures adopted by participants to deal with stress were sharing problems with others [223(56.2%)], meditation [132(56.8%)], performing yoga [50(12.8%)], sleeping [29(7.5%)], practicing Tai Chi [13(3.5%)] and listening to music [11(3%)]. Other methods like watching television and exercising were reported by 8(2.2%) participants each, aromatherapy and sports by 5(1.3%) each, eating favourite food and consuming alcohol by two each and browsing through the internet by one participant.

Majority of the students preferred sharing their personal problems with parents 211(52.7%), followed by friends 202(50.5%), siblings 71(17.7%) and others 26(6.5%).

Eight(2%) participants reported using medications for the management of stress. One of them had taken Lorazepam tablets while another Sertraline tablets. The rest of them did not specify the medications.

Reasons like lack of sufficient vacations and worrying about future were found to have highly significant association with academic stress among participants ( p ≤ 0.001). (Table 5 ).

Coping with stress was average/good among 328(98.8%) participants with moderate/severe levels of academic stress in comparison to 57(83.8%) with mild level of academic stress ( p < 0.00001).

Similarly correlation of academic stress scores with stress coping scores was found to be significant (r = 0.467, p < 0.001). Also correlation between academic stress scores with passive emotional (r = 0.513, p < 0.001) and passive problem (r = 0.401, p < 0.001) coping behaviours were found to be significant. However academic stress was not significantly correlated with active emotional (r = − 0.036, p = 0.468) and active problem (r = 0.072, p = 0.149) coping behaviours.

Binary logistic regression analysis found worrying about future ( p = 0.023) and poor self-esteem ( p = 0.026) among participants to be significantly associated with academic stress after adjusting the confounding effect of other variables in the model. (Table 6 ).

For calculating unadjusted Odds Ratio and 95% CI, participants staying with friends/alone were compared with those staying with parents/siblings/relatives (reference value), participants reporting speed of internet connection at place of stay as average/poor were compared with those reporting good connectivity (reference value).

An interesting fact about this study was that the response rate was total. This supports the importance of this study which addresses a felt need of every medical student.

Academic stress of moderate to severe level were reported among 83% participants in this study. In other studies done among medical students, academic stress was reported among 50% (Dyrbye et al. 2008 ), 53% (Bamuhair et al. 2015 ), 61% (Zamroni et al. 2018 ) and 74.6% (Mostafavian et al. 2018 ) participants. Academic stress among university students of other courses were reported among 48.8% (Reddy et al. 2018 ), 70.7% (Sharififard et al. 2014 ) and 73% (Adiele et al. 2018 ) participants. From these comparisons, it was obvious that academic stress was high among the participants in this study probably because of cultural factors.

There was no association between academic stress and gender of participants in this study as also reported by Mostafavian et al. ( 2018 ) and Zamroni et al. ( 2018 ). However several other studies done among university students reported females to have significantly greater academic stress than males (Adiele et al. 2018 ; Bamuhair et al. 2015 ; Reddy et al. 2018 ; Al-Sowygh et al. 2013 ).

Academic stress was found to be more among medical students in the first year (Nakalema and Ssenyonga 2014 ; Abdulghani 2008 ) or in the final year (Bamuhair et al. 2015 ). This was in contrast to the findings in this study were no such association was observed.

Place of residence was not associated with academic stress in this study and also in the study done among medical students in Iran by Mostafavian et al. ( 2018 ).

Academic stress in the present study was found to be least among participants who were staying with their parents, siblings or relatives. This may be because, number of students at this setting are outsiders. Studying over here, might also be their first occasion of moving out of their home environment. They therefore may be lacking their previously learnt support system such as banking on their family members and childhood friends during difficult times, as also observed by Kumar and Nancy ( 2011 ). They now have to find solutions to various problems by themselves, or by being dependent looking out for newer social contacts. If they were staying with their family members, perhaps they might have received the necessary emotional support during examinations and other stressful situations. The other benefits like getting hygienic food, good living conditions and people to take care of one’s health would have been best when family members were around. The observations in this study were however contradicting the observation of Mostafavian et al. ( 2018 ) who observed that the academic stress was significantly more among those living at their houses compared to those at dormitories.

As many as 60% participants regretted having wasted time set apart for their studies. Poor time management was found to be associated with academic stress by other researchers too (Misra and McKean 2000 ; Macan et al. 1990 ). Good time management skills involves prioritization of activities and judicious usage of time available for organization of the tasks to be completed. Time management was found to determine academic performance by Misra and McKean ( 2000 ). Moreover those with sound time management behaviour were found to have fewer psychological and physical symptoms related to stress (Misra and McKean 2000 ; Macan et al. 1990 ). Lammers et al. ( 2001 ) reported that close to half of the students had notable weaknesses in their time management skills.

Fear of failure in exams and falling short of attendance towards the end were the reasons for academic stress among more than half the participants in this study. Teachers can play an important role in alleviating examination related fears and anxieties by conducting frequent mock examinations (Sharma et al. 2011 ). Meeting individual students’ needs (Aherne et al. 2016 ), to find out the reason for missing classes, time scheduling of activities and providing constructive feedback to students (Sharma et al. 2016 ) are the other recommended strategies advised by previous researchers. Abouserie ( 1994 ) stated that the amount of guidance and support offered by teachers would be a key factor in determining the stress levels of students in any institution. Students themselves have opined that social support from teachers and peer groups, consulting services, and various extracurricular activities are the most useful strategies to deal with stress (Chang et al. 2012 ). As opined by the student community themselves, every institution need to offer them psychotherapy sessions, trainings for reducing emotional tension and opportunities to improve social intelligence (Ruzhenkov et al. 2016 ).

Issues like worrying about future and poor self-esteem among participants in this study were significantly associated with academic stress in the multivariable analysis model. These problems may be related to issues like concern about clearing the increasingly competitive entrance exams and also about the fear of them not being able to pursue the specialty of their choice in future. To address such sensitive problems, there is a need of the placement of a professional counsellor at various professional colleges. Pressley and McCormick ( 1995 ) also suggested that the learning environment within classrooms should be non-competitive, collaborative and task-oriented and not performance oriented, so as to create a stress free learning environment.

Having said this, the course work at medical schools should not be too light either. Kanter ( 2008 ) suggested that this approach can affect the quality of education. Rather students need to be trained in the right way to directly solve the problems related to academic stress by themselves being a part of a self-help program (Chen et al. 2013 ; Aherne et al. 2016 ).

The various sources of academic stress among medical students listed in other studies were, vastness of curriculum as reported by 61.6% (Anuradha et al. 2017 ), 82.2% (Bamuhair et al. 2015 ), and 82.3% (Oku et al. 2015 ), fear of failure in examination by 61.8% (Anuradha et al. 2017 ), frequency of examination by 52.2% (Anuradha et al. 2017 ), lack of recreation and inadequate holidays by 51.8% (Anuradha et al. 2017 ) and by 76.4% (Oku et al. 2015 ), sleep related problems by 64.3% (Bamuhair et al. 2015 ), worrying about future by 78.2% (Bamuhair et al. 2015 ), family problems by 54% (Bamuhair et al. 2015 ), interpersonal conflicts by 57.1% (Bamuhair et al. 2015 ), low self-esteem by 51.7% (Bamuhair et al. 2015 ) and transportation problems by 56.2% participants (Bamuhair et al. 2015 ).

Coping with stress was found to be average among 95% participants in the present study. Almost three-fourth of the participants in the present study tried to think or do something that would make them feel happier and relaxed when they were stressed. Coping methods commonly used by students in previous studies were effective time management, sharing of problems, planned problem solving, going out with friends, social support, meditation and getting adequate sleep. Even emotion-based strategies to cope stress like self-blaming and taking self-responsibility have been reported (Wolf 1994 ; Supe 1998 ; Stern et al. 1993 ; Redhwan et al. 2009 ).

Coping with stress in this study was better among participants with higher levels of academic stress which was similarly observed among Saudi Arabian medical students by Bamuhair et al. ( 2015 ). This suggests that students who perceived greater academic stress where in a position to apply coping strategies against it in a much better way. However the significant correlation between academic stress scores and passive emotional and passive problem scores indicates that the coping behaviour adopted by participants to deal with stress was not satisfactory. Therefore counselling the participants to adopt active coping behaviours is very essential at this setting. In a study done in Ghana by Atindanbila and Abasimi ( 2011 ), wrong or inadequate coping strategies were practiced by university students resulting in reduction of academic stress by mere 4%. Bamuhair et al. ( 2015 ) observed that 32.1% medical students felt too often that, they could not cope with stress. Therefore coping strategies against academic stress among university students in other parts of the world was not satisfactory either. The coping strategies adopted are generally found to vary depending on socio-cultural factors like region, social group, gender, age, and by individuals’ previous experiences as per the WHO/EHA ( 1998 ).

Passive emotional and problem coping behaviours were significantly more among males. This meant that males adopted a number of unhealthy behaviours to deal with academic stress. Unpleasant social coping behaviour was found to reduce social support and increase loneliness by Kato ( 2002 ). Felsten ( 1998 ) observed that specifically procrastination as a coping behaviour was found to result in depression in both men and women.

Female students on the other hand had significantly better active problem scores under coping behaviour. They were hence more mature and composed than the male participants in analysing the centre of the problem in a calm and optimistic manner, and in finding solutions for the same. Bamuhair et al. ( 2015 ) observed that the mean of coping strategies score was significantly higher among females. Females were also found to be better at time management compared to their male counterparts (Misra and McKean 2000 ; Khatib 2014 ). Males therefore need to be counselled about healthy coping behaviours in dealing with academic stress.

Al-Sowygh et al. ( 2013 ) observed that the denial and behaviour disengagement as stress coping strategies were reported to be significantly more among females while self-blame was reported to be more among males. Bang ( 2009 ) reported that the coping mechanism of choice is related to the differences in the roles expected from gender. Males are expected to deal stressful situations by their outward actions while females are expected to focus on emotions and seek social support. Soffer ( 2010 ) stated that women usually choose health-promoting behaviours while men prefer health-risky behaviours.

There was no association between age of participants with the perceived level of academic stress or with the level of adaptability to cope with it in this study supporting the observations of Bamuhair et al. ( 2015 ).

Limitations

This was a cross-sectional study conducted in a single medical college. Therefore the findings of this study cannot be generalized to all medical students across India.

The results of the study reflect important insights into the nature of stress faced by the medical students and the ways they deal with the same. Academic stress was found to be common and was of moderate level in more than three-fourth of the participants. Level of coping with stress was found to be average among 95% of them. Worrying about future and poor self-esteem were independently associated with academic stress among students. Male participants adopted more of unhealthy means of coping with academic stress. Therefore they need to be educated regarding the healthy coping methods. Counselling sessions and other students’ support systems need to be more organized to cater to the issues like career guidance, healthy coping behaviours, time management and to improve the self-esteem among the affected. Attention should also be paid to make the study environment in the classrooms more stress free without excessive academic load. Educating students about unpleasant consequences of stress is equally important. Teachers can also play a constructive role in mentoring and guiding students regarding choosing the right measures to cope with stress. Interactive academic sessions on stress control can further encourage medical students to single out each and every problematic issue. This would accomplish the aim of reducing the academic stress, adopting healthy academic stress coping behaviours, improving academic performance and minimizing anxiety among those with forethoughts about their future professional careers.

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Acknowledgements

We authors thank all the medical students of who took part in this study.

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This manuscript has been read and approved by all the authors, the requirements for authorship as stated earlier in this document have been met, and each author believes that the manuscript represents honest work.

Nitin Joseph: guarantor of this research work, design, literature search, tool preparation, manuscript preparation, revising the work critically for important intellectual content.

Aneesha Nallapati: data collection, data analysis, statistical analysis, interpretation of data, revising the work critically for important intellectual content.

Mitchelle Xavier Machado: data collection, data entry, literature search, manuscript preparation, manuscript editing, revising the work critically for important intellectual content.

Varsha Nair: concept of this study, data collection, data entry, manuscript editing, revising the work critically for important intellectual content.

Shreya Matele: data collection, literature search, manuscript editing, revising the work critically for important intellectual content.

Navya Muthusamy: data collection, literature search, manuscript editing, revising the work critically for important intellectual content.

Aditi Sinha: data collection, literature search, manuscript editing, revising the work critically for important intellectual content.

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Joseph, N., Nallapati, A., Machado, M.X. et al. Assessment of academic stress and its coping mechanisms among medical undergraduate students in a large Midwestern university. Curr Psychol 40 , 2599–2609 (2021). https://doi.org/10.1007/s12144-020-00963-2

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ORIGINAL RESEARCH article

Academic stress and mental well-being in college students: correlations, affected groups, and covid-19.

$\nGeorgia Barbayannis&#x;$

1 Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, United States
2 Rutgers New Jersey Medical School, Newark, NJ, United States
3 Office for Diversity and Community Engagement, Rutgers New Jersey Medical School, Newark, NJ, United States
4 Department of Biology, The College of New Jersey, Ewing, NJ, United States

Introduction

Late adolescence and emerging adulthood are transitional periods marked by major physiological and psychological changes, including elevated stress ( Hogan and Astone, 1986 ; Arnett, 2000 ; Shanahan, 2000 ; Spear, 2000 ; Scales et al., 2015 ; Romeo et al., 2016 ; Barbayannis et al., 2017 ; Chiang et al., 2019 ; Lally and Valentine-French, 2019 ; Matud et al., 2020 ). This pattern is particularly true for college students. According to a 2015 American College Health Association-National College Health Assessment survey, three in four college students self-reported feeling stressed, while one in five college students reported stress-related suicidal ideation ( Liu, C. H., et al., 2019 ; American Psychological Association, 2020 ). Studies show that a stressor experienced in college may serve as a predictor of mental health diagnoses ( Pedrelli et al., 2015 ; Liu, C. H., et al., 2019 ; Karyotaki et al., 2020 ). Indeed, many mental health disorders, including depression, anxiety, and substance abuse disorder, begin during this period ( Blanco et al., 2008 ; Pedrelli et al., 2015 ; Saleh et al., 2017 ; Reddy et al., 2018 ; Liu, C. H., et al., 2019 ).

Stress experienced by college students is multi-factorial and can be attributed to a variety of contributing factors ( Reddy et al., 2018 ; Karyotaki et al., 2020 ). A growing body of evidence suggests that academic-related stress plays a significant role in college ( Misra and McKean, 2000 ; Dusselier et al., 2005 ; Elias et al., 2011 ; Bedewy and Gabriel, 2015 ; Hj Ramli et al., 2018 ; Reddy et al., 2018 ; Pascoe et al., 2020 ). For instance, as many as 87% of college students surveyed across the United States cited education as their primary source of stress ( American Psychological Association, 2020 ). College students are exposed to novel academic stressors, such as an extensive academic course load, substantial studying, time management, classroom competition, financial concerns, familial pressures, and adapting to a new environment ( Misra and Castillo, 2004 ; Byrd and McKinney, 2012 ; Ekpenyong et al., 2013 ; Bedewy and Gabriel, 2015 ; Ketchen Lipson et al., 2015 ; Pedrelli et al., 2015 ; Reddy et al., 2018 ; Liu, C. H., et al., 2019 ; Freire et al., 2020 ; Karyotaki et al., 2020 ). Academic stress can reduce motivation, hinder academic achievement, and lead to increased college dropout rates ( Pascoe et al., 2020 ).

Academic stress has also been shown to negatively impact mental health in students ( Li and Lin, 2003 ; Eisenberg et al., 2009 ; Green et al., 2021 ). Mental, or psychological, well-being is one of the components of positive mental health, and it includes happiness, life satisfaction, stress management, and psychological functioning ( Ryan and Deci, 2001 ; Tennant et al., 2007 ; Galderisi et al., 2015 ; Trout and Alsandor, 2020 ; Defeyter et al., 2021 ; Green et al., 2021 ). Positive mental health is an understudied but important area that helps paint a more comprehensive picture of overall mental health ( Tennant et al., 2007 ; Margraf et al., 2020 ). Moreover, positive mental health has been shown to be predictive of both negative and positive mental health indicators over time ( Margraf et al., 2020 ). Further exploring the relationship between academic stress and mental well-being is important because poor mental well-being has been shown to affect academic performance in college ( Tennant et al., 2007 ; Eisenberg et al., 2009 ; Freire et al., 2016 ).

Perception of academic stress varies among different groups of college students ( Lee et al., 2021 ). For instance, female college students report experiencing increased stress than their male counterparts ( Misra et al., 2000 ; Eisenberg et al., 2007 ; Evans et al., 2018 ; Lee et al., 2021 ). Male and female students also respond differently to stressors ( Misra et al., 2000 ; Verma et al., 2011 ). Moreover, compared to their cisgender peers, non-binary students report increased stressors and mental health issues ( Budge et al., 2020 ). The academic year of study of the college students has also been shown to impact academic stress levels ( Misra and McKean, 2000 ; Elias et al., 2011 ; Wyatt et al., 2017 ; Liu, C. H., et al., 2019 ; Defeyter et al., 2021 ). While several studies indicate that racial/ethnic minority groups of students, including Black/African American, Hispanic/Latino, and Asian American students, are more likely to experience anxiety, depression, and suicidality than their white peers ( Lesure-Lester and King, 2004 ; Lipson et al., 2018 ; Liu, C. H., et al., 2019 ; Kodish et al., 2022 ), these studies are limited and often report mixed or inconclusive findings ( Liu, C. H., et al., 2019 ; Kodish et al., 2022 ). Therefore, more studies should be conducted to address this gap in research to help identify subgroups that may be disproportionately impacted by academic stress and lower well-being.

The coronavirus disease 19 (COVID-19) pandemic is a major stressor that has led to a mental health crisis ( American Psychological Association, 2020 ; Dong and Bouey, 2020 ). For college students, the COVID-19 pandemic has resulted in significant changes and disruptions to daily life, elevated stress levels, and mental and physical health deterioration ( American Psychological Association, 2020 ; Husky et al., 2020 ; Patsali et al., 2020 ; Son et al., 2020 ; Clabaugh et al., 2021 ; Lee et al., 2021 ; Lopes and Nihei, 2021 ; Yang et al., 2021 ). While any college student is vulnerable to these stressors, these concerns are amplified for members of minority groups ( Salerno et al., 2020 ; Clabaugh et al., 2021 ; McQuaid et al., 2021 ; Prowse et al., 2021 ; Kodish et al., 2022 ). Identifying students at greatest risk provides opportunities to offer support, resources, and mental health services to specific subgroups.

The overall aim of this study was to assess academic stress and mental well-being in a sample of college students. Within this umbrella, we had several goals. First, to determine whether a relationship exists between the two constructs of perceived academic stress, measured by the Perception of Academic Stress Scale (PAS), and mental well-being, measured by the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS), in college students. Second, to identify groups that could experience differential levels of academic stress and mental health. Third, to explore how the perception of the ongoing COVID-19 pandemic affected stress levels. We hypothesized that students who experienced more academic stress would have worse psychological well-being and that certain groups of students would be more impacted by academic- and COVID-19-related stress.

Materials and Methods

Survey instrument.

A survey was developed that included all questions from the Short Warwick-Edinburgh Mental Well-Being ( Tennant et al., 2007 ; Stewart-Brown and Janmohamed, 2008 ) and from the Perception of Academic Stress Scale ( Bedewy and Gabriel, 2015 ). The Short Warwick-Edinburgh Mental Well-Being Scale is a seven-item scale designed to measure mental well-being and positive mental health ( Tennant et al., 2007 ; Fung, 2019 ; Shah et al., 2021 ). The Perception of Academic Stress Scale is an 18-item scale designed to assess sources of academic stress perceived by individuals and measures three main academic stressors: academic expectations, workload and examinations, and academic self-perceptions of students ( Bedewy and Gabriel, 2015 ). These shorter scales were chosen to increase our response and study completion rates ( Kost and de Rosa, 2018 ). Both tools have been shown to be valid and reliable in college students with Likert scale responses ( Tennant et al., 2007 ; Bedewy and Gabriel, 2015 ; Ringdal et al., 2018 ; Fung, 2019 ; Koushede et al., 2019 ). Both the SWEMWBS and PAS scores are a summation of responses to the individual questions in the instruments. For the SWEMWBS questions, a higher score indicates better mental health, and scores range from 7 to 35. Similarly, the PAS questions are phrased such that a higher score indicates lower levels of stress, and scores range from 18 to 90. We augmented the survey with demographic questions (e.g., age, gender, and race/ethnicity) at the beginning of the survey and two yes/no questions and one Likert scale question about the impact of the COVID-19 pandemic at the end of our survey.

Participants for the study were self-reported college students between the ages of 18 and 30 years who resided in the United States, were fluent in English, and had Internet access. Participants were solicited through Prolific ( https://prolific.co ) in October 2021. A total of 1,023 individuals enrolled in the survey. Three individuals did not agree to participate after beginning the survey. Two were not fluent in English. Thirteen individuals indicated that they were not college students. Two were not in the 18–30 age range, and one was located outside of the United States. Of the remaining individuals, 906 were full-time students and 96 were part-time students. Given the skew of the data and potential differences in these populations, we removed the part-time students. Of the 906 full-time students, 58 indicated that they were in their fifth year of college or higher. We understand that not every student completes their undergraduate studies in 4 years, but we did not want to have a mixture of undergraduate and graduate students with no way to differentiate them. Finally, one individual reported their age as a non-number, and four individuals did not answer a question about their response to the COVID-19 pandemic. This yielded a final sample of 843 college students.

Data Analyses

After reviewing the dataset, some variables were removed from consideration due to a lack of consistency (e.g., some students reported annual income for themselves and others reported family income) or heterogeneity that prevented easy categorization (e.g., field of study). We settled on four variables of interest: gender, race/ethnicity, year in school, and response to the COVID-19 pandemic ( Table 1 ). Gender was coded as female, male, or non-binary. Race/ethnicity was coded as white or Caucasian; Black or African American; East Asian; Hispanic, Latino, or of Spanish origin; or other. Other was used for groups that were not well-represented in the sample and included individuals who identified themselves as Middle Eastern, Native American or Alaskan Native, and South Asian, as well as individuals who chose “other” or “prefer not to answer” on the survey. The year of study was coded as one through four, and COVID-19 stress was coded as two groups, no change/neutral response/reduced stress or increased stress.

Table 1 . Characteristics of the participants in the study.

Our first goal was to determine whether there was a relationship between self-reported academic stress and mental health, and we found a significant correlation (see Results section). Given the positive correlation, a multivariate analysis of variance (MANOVA) with a model testing the main effects of gender, race/ethnicity, and year of study was run in SPSS v 26.0. A factorial MANOVA would have been ideal, but our data were drawn from a convenience sample, which did not give equal representation to all groupings, and some combinations of gender, race/ethnicity, and year of study were poorly represented (e.g., a single individual). As such, we determined that it would be better to have a lack of interaction terms as a limitation to the study than to provide potentially spurious results. Finally, we used chi-square analyses to assess the effect of potential differences in the perception of the COVID-19 pandemic on stress levels in general among the groups in each category (gender, race/ethnicity, and year of study).

In terms of internal consistency, Cronbach's alpha was 0.82 for the SMEMWBS and 0.86 for the PAS. A variety of descriptors have been applied to Cronbach's alpha values. That said, 0.7 is often considered a threshold value in terms of acceptable internal consistency, and our values could be considered “high” or “good” ( Taber, 2018 ).

The participants in our study were primarily women (78.5% of respondents; Table 1 ). Participants were not equally distributed among races/ethnicities, with the majority of students selecting white or Caucasian (66.4% of responders; Table 1 ), or years of study, with fewer first-year students than other groups ( Table 1 ).

Students who reported higher academic stress also reported worse mental well-being in general, irrespective of age, gender, race/ethnicity, or year of study. PAS and SWEMWBS scores were significantly correlated ( r = 0.53, p < 0.001; Figure 1 ), indicating that a higher level of perceived academic stress is associated with worse mental well-being in college students within the United States.

Figure 1 . SWEMWBS and PAS scores for all participants.

Among the subgroups of students, women, non-binary students, and second-year students reported higher academic stress levels and worse mental well-being ( Table 2 ; Figures 2 – 4 ). In addition, the combined measures differed significantly between the groups in each category ( Table 2 ). However, as measured by partial eta squared, the effect sizes were relatively small, given the convention of 0.01 = small, 0.06 = medium, and 0.14 = large differences ( Lakens, 2013 ). As such, there were only two instances in which Tukey's post-hoc tests revealed more than one statistical grouping ( Figures 2 – 4 ). For SWEMWBS score by gender, women were intermediate between men (high) and non-binary individuals (low) and not significantly different from either group ( Figure 2 ). Second-year students had the lowest PAS scores for the year of study, and first-year students had the highest scores. Third- and fourth-year students were intermediate and not statistically different from the other two groups ( Figure 4 ). There were no pairwise differences in academic stress levels or mental well-being among racial/ethnic groups.

Table 2 . Results of the MANOVA.

Figure 2 . SWEMWBS and PAS scores according to gender (mean ± SEM). Different letters for SWEMWBS scores indicate different statistical groupings ( p < 0.05).

Figure 3 . SWEMWBS and PAS scores according to race/ethnicity (mean ± SEM).

Figure 4 . SWEMWBS and PAS scores according to year in college (mean ± SEM). Different letters for PAS scores indicate different statistical groupings ( p < 0.05).

The findings varied among categories in terms of stress responses due to the COVID-19 pandemic ( Table 3 ). For gender, men were less likely than women or non-binary individuals to report increased stress from COVID-19 (χ 2 = 27.98, df = 2, p < 0.001). All racial/ethnic groups responded similarly to the pandemic (χ 2 = 3.41, df = 4, p < 0.49). For the year of study, first-year students were less likely than other cohorts to report increased stress from COVID-19 (χ 2 = 9.38, df = 3, p < 0.03).

Table 3 . Impact of COVID-19 on stress level by gender, race/ethnicity, and year of study.

Our primary findings showed a positive correlation between perceived academic stress and mental well-being in United States college students, suggesting that academic stressors, including academic expectations, workload and grading, and students' academic self-perceptions, are equally important as psychological well-being. Overall, irrespective of gender, race/ethnicity, or year of study, students who reported higher academic stress levels experienced diminished mental well-being. The utilization of well-established scales and a large sample size are strengths of this study. Our results extend and contribute to the existing literature on stress by confirming findings from past studies that reported higher academic stress and lower psychological well-being in college students utilizing the same two scales ( Green et al., 2021 ; Syed, 2021 ). To our knowledge, the majority of other prior studies with similar findings examined different components of stress, studied negative mental health indicators, used different scales or methods, employed smaller sample sizes, or were conducted in different countries ( Li and Lin, 2003 ; American Psychological Association, 2020 ; Husky et al., 2020 ; Pascoe et al., 2020 ; Patsali et al., 2020 ; Clabaugh et al., 2021 ; Lee et al., 2021 ; Lopes and Nihei, 2021 ; Yang et al., 2021 ).

This study also demonstrated that college students are not uniformly impacted by academic stress or pandemic-related stress and that there are significant group-level differences in mental well-being. Specifically, non-binary individuals and second-year students were disproportionately impacted by academic stress. When considering the effects of gender, non-binary students, in comparison to gender-conforming students, reported the highest stress levels and worst psychological well-being. Although there is a paucity of research examining the impact of academic stress in non-binary college students, prior studies have indicated that non-binary adults face adverse mental health outcomes when compared to male and female-identifying individuals ( Thorne et al., 2018 ; Jones et al., 2019 ; Budge et al., 2020 ). Alarmingly, Lipson et al. (2019) found that gender non-conforming college students were two to four times more likely to experience mental health struggles than cisgender students ( Lipson et al., 2019 ). With a growing number of college students in the United States identifying as as non-binary, additional studies could offer invaluable insight into how academic stress affects this population ( Budge et al., 2020 ).

In addition, we found that second-year students reported the most academic-related distress and lowest psychological well-being relative to students in other years of study. We surmise this may be due to this group taking advanced courses, managing heavier academic workloads, and exploring different majors. Other studies support our findings and suggest higher stress levels could be attributed to increased studying and difficulties with time management, as well as having less well-established social support networks and coping mechanisms compared to upperclassmen ( Allen and Hiebert, 1991 ; Misra and McKean, 2000 ; Liu, X et al., 2019 ). Benefiting from their additional experience, upperclassmen may have developed more sophisticated studying skills, formed peer support groups, and identified approaches to better manage their academic stress ( Allen and Hiebert, 1991 ; Misra and McKean, 2000 ). Our findings suggest that colleges should consider offering tailored mental health resources, such as time management and study skill workshops, based on the year of study to improve students' stress levels and psychological well-being ( Liu, X et al., 2019 ).

Although this study reported no significant differences regarding race or ethnicity, this does not indicate that minority groups experienced less academic stress or better mental well-being ( Lee et al., 2021 ). Instead, our results may reflect the low sample size of non-white races/ethnicities, which may not have given enough statistical power to corroborate. In addition, since coping and resilience are important mediators of subjective stress experiences ( Freire et al., 2020 ), we speculate that the lower ratios of stress reported in non-white participants in our study (75 vs. 81) may be because they are more accustomed to adversity and thereby more resilient ( Brown, 2008 ; Acheampong et al., 2019 ). Furthermore, ethnic minority students may face stigma when reporting mental health struggles ( Liu, C. H., et al., 2019 ; Lee et al., 2021 ). For instance, studies showed that Black/African American, Hispanic/Latino, and Asian American students disclose fewer mental health issues than white students ( Liu, C. H., et al., 2019 ; Lee et al., 2021 ). Moreover, the ability to identify stressors and mental health problems may manifest differently culturally for some minority groups ( Huang and Zane, 2016 ; Liu, C. H., et al., 2019 ). Contrary to our findings, other studies cited racial disparities in academic stress levels and mental well-being of students. More specifically, Negga et al. (2007) concluded that African American college students were more susceptible to higher academic stress levels than their white classmates ( Negga et al., 2007 ). Another study reported that minority students experienced greater distress and worse mental health outcomes compared to non-minority students ( Smith et al., 2014 ). Since there may be racial disparities in access to mental health services at the college level, universities, professors, and counselors should offer additional resources to support these students while closely monitoring their psychological well-being ( Lipson et al., 2018 ; Liu, C. H., et al., 2019 ).

While the COVID-19 pandemic increased stress levels in all the students included in our study, women, non-binary students, and upperclassmen were disproportionately affected. An overwhelming body of evidence suggests that the majority of college students experienced increased stress levels and worsening mental health as a result of the pandemic ( Allen and Hiebert, 1991 ; American Psychological Association, 2020 ; Husky et al., 2020 ; Patsali et al., 2020 ; Son et al., 2020 ; Clabaugh et al., 2021 ; Lee et al., 2021 ; Yang et al., 2021 ). Our results also align with prior studies that found similar subgroups of students experience disproportionate pandemic-related distress ( Gao et al., 2020 ; Clabaugh et al., 2021 ; Hunt et al., 2021 ; Jarrett et al., 2021 ; Lee et al., 2021 ; Chen and Lucock, 2022 ). In particular, the differences between female students and their male peers may be the result of different psychological and physiological responses to stress reactivity, which in turn may contribute to different coping mechanisms to stress and the higher rates of stress-related disorders experienced by women ( Misra et al., 2000 ; Kajantie and Phillips, 2006 ; Verma et al., 2011 ; Gao et al., 2020 ; Graves et al., 2021 ). COVID-19 was a secondary consideration in our study and survey design, so the conclusions drawn here are necessarily limited.

The implications of this study are that college students facing increased stress and struggling with mental health issues should receive personalized and specific mental health services, resources, and support. This is particularly true for groups that have been disproportionately impacted by academic stress and stress due to the pandemic. Many students who experience mental health struggles underutilize college services due to cost, stigma, or lack of information ( Cage et al., 2020 ; Lee et al., 2021 ). To raise awareness and destigmatize mental health, colleges can consider distributing confidential validated assessments, such as the PAS and SWEMWBS, in class and teach students to self-score ( Lee et al., 2021 ). These results can be used to understand how academic stress and mental well-being change over time and allow for specific and targeted interventions for vulnerable groups. In addition, teaching students healthy stress management techniques has been shown to improve psychological well-being ( Alborzkouh et al., 2015 ). Moreover, adaptive coping strategies, including social and emotional support, have been found to improve the mental well-being of students, and stress-reduction peer support groups and workshops on campus could be beneficial in reducing stress and improving the self-efficacy of students ( Ruthig et al., 2009 ; Baqutayan, 2011 ; Bedewy and Gabriel, 2015 ; Freire et al., 2020 ; Green et al., 2021 ; Suresh et al., 2021 ). Other interventions that have been effective in improving the coping skills of college students include cognitive-behavioral therapy, mindfulness mediation, and online coping tools ( Kang et al., 2009 ; Regehr et al., 2013 ; Molla Jafar et al., 2015 ; Phang et al., 2015 ; Houston et al., 2017 ; Yusufov et al., 2019 ; Freire et al., 2020 ). Given that resilience has also been shown to help mediate stress and improve mental well-being during the COVID-19 pandemic, interventions focusing on enhancing resilience should be considered ( Surzykiewicz et al., 2021 ; Skalski et al., 2022 ). Telemental health resources across colleges can also be implemented to reduce stigma and improve at-risk students' access to care ( Toscos et al., 2018 ; Hadler et al., 2021 ). University campuses, professors, and counselors should consider focusing on fostering a more equitable and inclusive environment to encourage marginalized students to seek mental health support ( Budge et al., 2020 ).

Limitations

While our study has numerous strengths, including using standardized instruments and a large sample size, this study also has several limitations due to both the methodology and sample. First, the correlational study design precludes making any causal relationships ( Misra and McKean, 2000 ). Thereby, our findings should be taken in the context of academic stress and mental well-being, and recognize that mental health could be caused by other non-academic factors. Second, the PAS comprised only the perception of responses to academic stress, but stress is a multi-factorial response that encompasses both perceptions and coping mechanisms to different stressors, and the magnitude of stress varies with the perception of the degree of uncontrollability, unpredictability, or threat to self ( Miller, 1981 ; Hobfoll and Walfisch, 1984 ; Lazarus and Folkman, 1984 ; Wheaton, 1985 ; Perrewé and Zellars, 1999 ; Schneiderman et al., 2005 ; Bedewy and Gabriel, 2015 ; Schönfeld et al., 2016 ; Reddy et al., 2018 ; Freire et al., 2020 ; Karyotaki et al., 2020 ). Third, the SWEMSBS used in our study and the data only measured positive mental health. Mental health pathways are numerous and complex, and are composed of distinct and interdependent negative and positive indicators that should be considered together ( Margraf et al., 2020 ). Fourth, due to the small effect sizes and unequal representation for different combinations of variables, our analysis for both the PAS and SWEMSBS included only summed-up scales and did not examine group differences in response to the type of academic stressors or individual mental health questions.

An additional limitation is that the participants in our study were a convenience sample. The testing service we used, prolific.co, self-reports a sample bias toward young women of high levels of education (i.e., WEIRD bias) ( Team Prolific, 2018 ). The skew toward this population was observed in our data, as 80% of our participants were women. While we controlled for these factors, the possibility remains that the conclusions we draw for certain groups, such as nonbinary students, ethnic/racial minorities, and men, may not be as statistically powerful as they should be. Moreover, our pre-screening was designed to recruit undergraduate level, English-speaking, 18–30-year-olds who resided in the United States. This resulted in our participant demographics being skewed toward the WEIRD bias that was already inherent in the testing service we used. Future research will aim to be more inclusive of diverse races/ethnicities, sexual orientations, languages, educational backgrounds, socioeconomic backgrounds, and first-generation college students.

Another limitation of our study is the nature of satisficing. Satisficing is a response strategy in which a participant answers a question to satisfy its condition with little regard to the quality or accuracy of the answer ( Roberts et al., 2019 ). Anonymous participants are more likely to satisfice than respondents who answer the question face-to-face ( Krosnick et al., 2002 ). We sought to mitigate satisficing by offering financial incentives to increase response rates and decrease straight-lining, item skipping, total missing items, and non-completion ( Cole et al., 2015 ). Concerns of poor data quality due to surveys offering financial incentives found little evidence to support that claim and may do the opposite ( Cole et al., 2015 ). On the other hand, social desirability bias may have influenced the participant's self-reported responses, although our anonymous survey design aimed to reduce this bias ( Joinson, 1999 ; Kecojevic et al., 2020 ).

Future Studies

Future studies should replicate our study to validate our results, conduct longitudinal cohort studies to examine well-being and perceived academic stress over time, and aim for a more representative student sample that includes various groups, including diverse races/ethnicities, sexual orientations, socioeconomic backgrounds, languages, educational levels, and first-generation college students. Additionally, these studies should consider examining other non-academic stressors and students' coping mechanisms, both of which contribute to mental health and well-being ( Lazarus and Folkman, 1984 ; Freire et al., 2020 ). Further explorations of negative and other positive indicators of mental health may offer a broader perspective ( Margraf et al., 2020 ). Moreover, future research should consider extending our work by exploring group differences in relation to each factor in the PAS (i.e., academic expectations, workload and examinations, and self-perception of students) and SWEMBS to determine which aspects of academic stress and mental health were most affected and allow for the devising of targeted stress-reduction approaches. Ultimately, we hope our research spurs readers into advocating for greater academic support and access to group-specific mental health resources to reduce the stress levels of college students and improve their mental well-being.

Utilizing two well-established scales, our research found a statistically significant correlation between the perceived academic stress of university students and their mental well-being (i.e., the higher the stress, the worse the well-being). This relationship was most apparent among gender and grade levels. More specifically, non-binary and second-year students experienced greater academic burden and lower psychological well-being. Moreover, women, non-binary students, and upper-level students were disproportionately impacted by stress related to the COVID-19 pandemic.

Studies regarding broad concepts of stress and well-being using a questionnaire are limited, but our study adds value to the understanding of academic stress as a contributor to the overall well-being of college students during this specific point in time (i.e., the COVID-19 pandemic). Competition both for admission to college ( Bound et al., 2009 ) and during college ( Posselt and Lipson, 2016 ) has increased over time. Further, selective American colleges and universities draw applicants from a global pool. As such, it is important to document the dynamics of academic stress with renewed focus. We hope that our study sparks interest in both exploring and funding in-depth and well-designed psychological studies related to stress in colleges in the future.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics Statement

The studies involving human participants were reviewed and approved by Institutional Review Board at Rutgers University. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

GB and MB contributed to conceptualization, study design, IRB application, manuscript drafting, and revision. XZ participated in the conceptualization and design of the questionnaires. HB participated in subject recruitment and questionnaire collection. KP contributed to data analysis, table and figure preparation, manuscript drafting, and revision. XM contributed to conceptualization, study design, IRB application, supervision of the project, manuscript drafting, and revision. All authors contributed to the article and approved the submitted version.

This study was made possible by a generous donation from the Knights of Columbus East Hanover Chapter in New Jersey.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Acknowledgments

The authors wish to thank Shivani Mehta and Varsha Garla for their assistance with the study. We also thank all the participants for their efforts in the completion of the study.

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Keywords: academic stress, well-being, college students, Perception of Academic Stress, Short Warwick-Edinburgh Mental Well-Being Scale, COVID-19

Citation: Barbayannis G, Bandari M, Zheng X, Baquerizo H, Pecor KW and Ming X (2022) Academic Stress and Mental Well-Being in College Students: Correlations, Affected Groups, and COVID-19. Front. Psychol. 13:886344. doi: 10.3389/fpsyg.2022.886344

Received: 28 February 2022; Accepted: 20 April 2022; Published: 23 May 2022.

Reviewed by:

Copyright © 2022 Barbayannis, Bandari, Zheng, Baquerizo, Pecor and Ming. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Keith W. Pecor, pecor@tcnj.edu

† These authors have contributed equally to this work and share first authorship

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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ACADEMIC STRESS AND ACADEMIC PERFORMANCE OF BEEd STUDENTS OF THE COLLEGE OF TEACHER EDUCATION IN OCCIDENTAL MINDORO STATE COLLEGE A THESIS PROPOSAL

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Associations Between Academic Stress, Mental Distress, Academic Self-Disclosure to Parents and School Engagement in Hong Kong

Associated data.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Numerous studies have indicated that academic stress is associated with various detrimental personal physical and emotional outcomes; however, relatively few studies have explored how academic stress affects adolescents' interactions with their significant others in families and schools, which are two important social systems for school-age adolescents. In addition, there are also few studies examining how academic stress influences adolescents' self-disclosure to parents and school engagement in East Asian districts particularly in Hong Kong, where the level of academic stress among adolescents is high. This study examines how academic stress affects mental distress, academic self-disclosure to parents and school engagement and explores gender differences in the risk for the outcomes of academic stress. One thousand and eight hundred and four students from eight secondary schools in Hong Kong participated in this study. The results indicate that academic stress has a significant association with all three outcomes, but the correlation with school engagement is positive, which is contrary to the findings of most previous studies. The possible reasons for such positive association are discussed. In addition, the model can be applied to both genders, but females are more susceptible to the detrimental outcomes of academic stress by suffering a higher level of mental distress. This study suggests that academic stress should be an important entry point to tackle adolescents' mental distress while interventions should be targeted at females who are experiencing a higher level of mental distress. In addition, in view of the significant associations between academic stress and self-disclosure to parents, as well as between academic stress and school engagement, suggestions are provided to families and schools on how to proactively provide support to those students who are experiencing academic stress.

Introduction

Academic stress is a growing and alarming threat to young people around the world ( 1 ). Research has indicated that adolescents across age groups, genders and cultural contexts are increasingly affected by academic stress ( 2 – 4 ). Empirical findings have also suggested that tremendous academic stress has detrimental impacts on mental wellbeing in young people, including somatic syndromes ( 5 – 7 ), anxiety ( 3 , 8 , 9 ), depression ( 3 , 8 , 9 ), suicidal attempts ( 10 , 11 ), and addictive habits ( 12 , 13 ). However, the sample of most of these studies is college students, while high-school students are seldom included in previous studies to examine how academic stress affects their mental health. Although mental health issues among high-school students are well-documented in Hong Kong ( 14 , 15 ), we are not sure whether these mental health problems are under the influence of academic stress. With this concern, the current study will examine how academic stress affects the level of mental distress among high-school students. The empirical findings of the present study can not only inform youth counselors about the effective way and entry point for handling mental distress among school-age students but also inform policy makers about the necessity of combating academic stress, as tremendous academic stress may have a great effect on students' mental wellbeing.

In addition, spillover theory and the ecology perspective inform us that emotional experiences in one setting will affect what happens in the other settings ( 16 – 18 ). Academic stress, one of the prominent sources of stress among school-age students, will likely affect adolescents' behavior in family and school settings, which are two primary contexts for personal development. However, there is a lack of findings showing how academic stress impacts school-age adolescents' behavior in school and family. In addition, theories and empirical studies have shown that there is a contrasting relationship between academic stress and school engagement in the Western context ( 19 , 20 ), little is known how academic stress impacts one's involvement in school in East Asian societies, where the school context is quite different from Western societies in terms of school curriculum, teacher-student ratio, and class size. In sum, the primary goal of the current study is to provide observed evidence on the relationship between academic stress and high school students' mental health, interaction with parents and school engagement. In addition, the effect of gender is also examined to determine which gender is at a greater risk of the effects of academic stress.

Literature Review

Academic stress and mental distress.

Research findings have indicated that academic stress is strongly associated with poor academic performance and procrastination ( 21 , 22 ), physical illness ( 5 – 7 ), symptoms of mental distress ( 3 , 8 , 9 , 23 – 25 ), suicidal ideations and attempts ( 10 , 11 ), and addictive behaviors ( 12 , 13 ). Among these detrimental outcomes, mental distress has received a great deal of attention from researchers and youth counselors. According to the World Health Organization, an estimated 20% of adolescents worldwide experience mental health problems ( 26 ). Empirical studies have indicated that academic stress is strongly associated with mental health issues, irrespective of the geographic locations or courses of study ( 3 , 27 , 28 ). However, the samples in most of these studies were college students or undergraduates who were studying a specific subject, such as medicine, or in a specific form, such as college freshmen ( 8 , 29 , 30 ). In Hong Kong, a few studies have examined how academic stress triggers anxiety in elementary students ( 31 , 32 ). Surprisingly, adolescents in high schools are underresearched in previous studies, particularly in Hong Kong. In addition, relatively few studies have investigated how academic stress among adolescents in high schools impacts their mental wellbeing. Adolescence, described as a period of “storm and stress” ( 33 ), is a period during which individuals are particularly vulnerable to academic stress ( 27 ). Their identity and values are somehow defined by their academic achievement, particularly through the evaluation and comments from their significant others, such as parents and teachers ( 34 , 35 ). In Chinese culture, families tend to place a strong emphasis on academic excellence and regard academic achievement as one of the few avenues for upward mobility and bring honor to one's family ( 36 , 37 ). In addition, children are socialized to be hypersensitive to the judgment of others, especially superiors such as parents and teachers. Therefore, in the context of academic stress, Asian students tend to put pressure on themselves to excel academically, and they also strive hard to meet the academic expectations of significant others, such as parents and teachers ( 38 , 39 ). Hence, when compared to their counterparts in the West, students in Hong Kong are more susceptible to academic stress triggered by high expectation from family and teachers or from themselves who are striving to satisfy their parents' educational aspiration ( 38 , 39 ). On the other hand, unlike college students who have almost secured a university degree, high school students in Hong Kong are facing an exit certificate examination; they may consider this period a critical juncture or fateful moment in their life, and it is of great importance to define their future ( 27 ). Consequently, adolescents in high schools have more opportunities to be exposed to academic stress and are more susceptible to its detrimental effects on their mental health. However, few studies have provided empirical evidence of how academic stress impacts mental distress in adolescents. Based on previous research, this study hypothesizes that students experiencing academic stress are more likely to develop mental distress.

Academic Stress and Its Spillover Effects to Other Social Systems

The ecological perspective advises that the social systems of adolescents are interconnected ( 18 ). The emotional experiences of high school students may inevitably affect and shape their behaviors in other social settings. The process by which experience in one setting influence behavior or experiences in other contexts is often referred to as spillover ( 16 ). The concept of spillover has been widely adopted to explain the linkages between work stress and family experience. For example, a man who is experiencing overwhelming work-related stress may exhaust his energy dealing with that stress and be unable to focus or pay attention, which may adversely affect the frequency and quality of his interactions with his family members ( 16 , 17 ). Although the concept of spillover offers a useful framework to examine the association between work stress and family experiences, it is rarely applied to examine how academic stress impacts the behaviors of high school students in their other social settings. To the best of our knowledge, the current study is one of the first to examine how academic stress affects interaction and engagement in family and school, which are the two primary contexts for their personal development. The findings of this study can not only provide empirical evidence of whether spillover theory can be applied in academic stress but also enrich theoretical knowledge about the effects of academic stress.

Academic Self-Disclosure to Parents

Academic self-disclosure to parents refers to the verbal communication of their thoughts, feelings and experiences in academic areas by adolescents to their parents ( 40 , 41 ). Self-disclosure, denoting one's willingness and actual behavior in communication, is an imperative basis for family interaction ( 42 ). In addition, adolescents' academic self-disclosure to parents plays an important role in allowing parents to have the information they need in a timely manner, enabling them to provide support and guidance to their children who are experiencing academic stress ( 42 ). In contrast, low level self-disclosure with parents may impede parents from knowing the academic difficulties that their children are facing ( 40 ). A question is what leads adolescents to not disclose their academic difficulties to their parents. Objective self-awareness theory explains that a negative mood caused by a discrepancy between the perceived standard and individual performance may foster withdrawal and inhibit disclosure ( 41 ). In addition, uncertainty is regarded as an important emotion governing self-disclosure ( 43 ). When adolescents feel vulnerable and anxious about the possible response on the part of the listener, the chance of self-disclosure is reduced ( 43 ). In other words, academic stress, a negative emotional state of adolescents, may induce hesitation and worry, which may in turn inhibit self-disclosure. In addition, when overwhelming academic stress accumulates to the point of burnout, students may become withdrawn and passive to disclose their academic issues to their significant others, including their parents ( 2 , 44 ). Although the above theory suggests that academic stress may influence the level of academic self-disclosure to parents, to the best of our knowledge, no study has provided empirical evidence showing whether academic stress affects self-disclosure to parents. Based on the literature, this study hypothesizes that academic stress is negatively associated with adolescents' academic self-disclosure to parents.

School Engagement

School engagement describes students' participation and involvement in the school setting. Although there are different definitions, researchers generally agree that school engagement is a multidimensional construct that is usually composed of three components ( 45 ), (1) cognitive engagement, which refers to students' investment in schoolwork, as well as their thoughtfulness, willingness to learn and willingness to make the necessary effort while studying; (2) emotional engagement, which refers to students' enjoyment of and interest in school-related challenges and their emotional reactions to their teachers and classmates; and (3) behavioral engagement, which refers to students' presence at school and compliance with school discipline rules ( 45 ). Studies on school engagement have consistently shown that engagement in high school brings favorable outcomes, including better academic achievement, positive teacher-student relationships, healthy psychological wellbeing, and even long-term positive benefits, such as better job opportunities and greater life satisfaction ( 46 ). In contrast, low engagement in school is associated with school dropout, a lack of motivation to learn and psychological distress ( 47 ).

Self-determination theory argues that the satisfaction of three basic psychological needs, i.e., competency, autonomy and relatedness, is essential for maintaining intrinsic motivation, and such motivation can foster participation and engagement in social systems ( 48 , 49 ). According to this theory and empirical findings, when students perceive a high level of stress in academics, they may experience a sense of failure in meeting academic demands. This may lead to feelings of incompetency, lack of confidence in their own ability to achieve academic success, and inability to connect with peers due to their own psychological distress. Thus, the three basic psychological needs are not satisfied. As a result, intrinsic motivation is inhibited, which may foster disengagement from school ( 19 , 20 , 49 ). The negative association between stress and school engagement was supported by several empirical studies conducted in the Western context ( 20 ). Nevertheless, the literature on stress posits that stress can have facilitative effects by motivating the individual to work hard to perform well in stressful situations if the stress level is still within the range in which coping remains possible ( 19 ). In other words, stress can have an activating effect, not only an inhibitory influence, on one's behavior and performance. A study has indicated that the more students report activating test anxiety, the greater they are engaged in school by paying more attention and participating more in lessons. In sum, these different empirical studies have contrasting predictions about how academic stress influences one's engagement in school. Most of these studies are conducted in Western societies, where the school system and context may vary substantially from those in East Asian countries with regard to the curriculum, class size and teacher-student ratio ( 46 ). Little is known about how academic stress affects school engagement in an East Asian context. Based on the literature, this study hypothesizes that academic stress is negatively associated with school engagement.

Effect of Gender

According to the literature on stress, gender plays a crucial role in predicting stress and stress escalation. Although most studies have indicated that girls experience a higher level of academic stress ( 50 , 51 ) and suffer more from the psychopathology associated with academic stress, the results of some studies have suggested that gender does not play a significant role in predicting stress and is not associated with academic stress ( 1 , 52 ). In addition, some studies have indicated that girls used to have a higher level of school engagement than boys ( 53 ), particularly as reflected in behaviors such as punctuality and regularly doing homework, which have traditionally been considered female characteristics ( 54 ). However, findings from one study suggested that test anxiety and stress have positive associations with school disengagement in both boys and girls ( 20 ). To extend our knowledge of how gender influences the connections between academic stress and its outcomes, a gender comparison was conducted in this study. Such an examination can not only advance our theoretical knowledge but also provide evidence that can be used to identify high-risk groups, facilitating the implementation of targeted prevention programs.

Current Study

Participants.

The data used in this study were collected from secondary 4–6 (grades 10–12) students from eight secondary schools in Hong Kong. Convenience sampling strategies were adopted in this study to obtain the data. Although the sample is not strictly representative, the participating schools have covered different bandings, denoting various academic performances, and across different districts in Hong Kong, implying that the students come from different families with different social economic statuses. A total of 2072 secondary 4–6 students were invited to participate in the research, while 258 students or their parents (12.5%) did not give consent to take part. Finally, a total of 1,814 students successfully participated. Ten questionnaires were excluded because they were returned incomplete. As a result, the final data set consisted of 1,804 entries. Of the sample, 789 (43.8%) were boys, 1,012 (56.2%) were girls, and three did not indicate their gender. The grade-level distribution was as follows: 710 (39.4%) students were in secondary 4 (grade 10), 716 (39.7%) students were in secondary 5 (grade 11) and 378 (20.9%) students were in secondary 6 (grade 12).

To assess the adequacy of the scales and ascertain the reliability and validity of the measurement and to test how far the sample can understand the questions, a pilot test was conducted while a total of 124 secondary 4–6 (grades 10–12) students participating. Exploratory factor analysis using the data collected in the pilot test was conducted. The factor loadings of the individual items for each latent variable were generally adequate except for one item from the scale of academic self-disclosure to parents; thus, the item was deleted after the pilot test.

The researchers have conducted a briefing to class-teachers who then helped to deliver a self-administered anonymous survey in the classroom. The students were informed of the background of the study, and they were encouraged to respond truthfully. The questionnaire included 65 items asking about the participants' demographic information and their personal experiences in the school and the family. The survey took approximately 20 min to complete. Written consent was obtained from both students and their parents or guardians before the survey was administered. They were informed that their participation was entirely voluntary, and they were free to withdraw from the study at any time and for any reason. The questionnaire, the related procedures, the informed consent forms and the compliance with ethical practices were reviewed and supervised by the university with which the authors are affiliated.

The students were asked to indicate whether they were male or female.

Demographic Information

The students were asked to report their demographic background across ten items, including the year of education, age, parents' highest level of educational attainment, occupational background of parents, living arrangements of the family, family financial situation and their academic ranking in the class in the last semester.

Academic Stress

In the East Asian context, academic stress is mostly conceptualized as academic expectation stress, in which expectations come from parents, teachers and students themselves ( 39 , 55 ). In addition, frequent comparisons and excessive demands are the other two dimensions of academic stress ( 56 , 57 ) that are suggested in the literature. Hence, based on the literature and findings of previous studies, academic stress in this study is first operationalized with five dimensions, namely, academic expectation stress from parents, academic expectation stress from teachers, academic expectation stress from students themselves, frequent comparisons, and excessive demands. Items measuring these five dimensions were from various validated inventories ( 57 – 59 ) and were compiled as the initial scale of academic stress for this study. However, the result of an exploratory factor analysis indicated that there were four indicators of the variable instead of five. The items measuring “frequent comparisons” were finally incorporated into the indicator of “academic expectation stress from students themselves”, while the indicator of “excessive demands” remained even though its factor loading was slightly low.

Based on the findings of the pilot test, seventeen items were used to assess academic stress. These items asked students about their actual feelings regarding different descriptions. The items were rated on a 5-point Likert scale (“1 = totally disagree” to “5 = totally agree”). This latent variable consisted of four subscales with a total of 17 items. The first three subscales were academic expectations stress from parents (five items, factor loading = 0.71), academic expectations stress from teachers (three items, factor loading = 0.76) and academic expectations stress from the students themselves (six items, factor loading = 0.85). The fourth subscale was excessive demands (three items, factor loading = 0.46). All 17 items were selected from the inventories in research studies in Taiwan ( 47 – 49 ). The following are some sample questions: “I blame myself if I cannot meet my parents' academic expectations” (academic expectations stress from parents), “If I have a poor performance in school, I think my teachers are disappointed in me” (academic expectations stress from teachers), “If I cannot meet my own expectations, I am not good enough” (students' academic expectations stress) and “The assessments and examinations are too much for me, and I feel that they are unbearable” (excessive demands). The score for this scale was calculated by summing these 17 items, with a higher score indicating a higher level of academic stress. The Cronbach's alpha coefficient for these items was 0.919.

Mental Distress

The items of this latent variable were derived from the Brief Symptom Rating Scale (BSRS). This scale is a Chinese inventory that was developed and validated by Taiwanese psychiatrists and is used as a screening tool to identify common mental health problems ( 60 ). The Brief Symptom Rating Scale has 50 items with ten subscales, measuring different mental distress symptoms, namely, somatization, obsession, interpersonal sensitivity, depression, anxiety, hostility, phobia, paranoid, psychoticism and addiction. As depression, anxiety and somatization are common mental distress symptoms among adolescents, these three subscales were then selected to construct a latent variable of mental distress in this study. The item responses were given on a 5-point Likert scale (“1 = never” to “5 = very severe”). The three subscales are (1) depression (seven items, factor loading = 0.91), including the items “I feel lonely” and “I feel hopeless about the future”; (2) anxiety (seven items, factor loading = 0.95), including the items “I am scared” and “I feel unsettled and I cannot sit calmly”; and (3) somatization (five items, factor loading = 0.77), including the items “I feel that it is hard to breathe” and “I have chest pain.” The score for this scale was calculated by summing these 19 items, with a higher score indicating a higher level of mental distress. The Cronbach's alpha coefficient for these items was 0.957.

This variable was measured with five items that asked students about the extent to which they agreed with statements regarding academic self-disclosure to parents. The inventory was translated from the questionnaire developed by Kerr and Stattin ( 61 ). These five items were translated from English to Chinese to maintain a consistent language version of the questionnaire, and a standard back-translation procedure was employed to ensure accuracy. The original scale had six items, one of which was deleted after the pilot test because of its low factor loading. The responses to the items were given on a 5-point Likert scale (“1 = totally disagree” to “5 = totally agree”). The results of an exploratory factor analysis suggested that the scale was unidimensional. To build a robust latent structure for academic self-disclosure to parents, these five items were randomly placed into three parcels. The first parcel (factor loading = 0.93) included two items, i.e., “I can discuss my academic issues with my mother/father without feeling restrained or embarrassed” and “My parents try to understand my concerns and views regarding academics.” The second parcel (factor loading = 0.88) also included two items, i.e., “It is easy for me to express my true feelings about academics to my mother/father” and “My parents are good listeners.” The third parcel (factor loading = 0.84) had one item, i.e., “If I experienced academic difficulties, I would tell my mother/father.” The score for this scale was calculated by summing these five items, with a higher score indicating a high level of academic self-disclosure to parents. The Cronbach's alpha coefficient for these items was 0.917.

This variable was measured with eight items that asked the students about their views and feelings regarding school engagement. The items were selected from an inventory developed in Taiwan ( 62 ). The inventory has 29 items measuring the three dimensions of school engagement, i.e., cognitive, affective and behavioral engagement. The criteria for item selection were based on factor loadings and the content of the items to ensure the scale's reliability and validity. The responses to the items were given on a 5-point Likert scale (“1 = totally not met” to “5 = totally met”). The results of an exploratory factor analysis indicated that there were three factors: (1) cognitive engagement (two items, factor loading = 0.66), including the item “I will try different ways to understand the teacher's lecture during class;” (2) affective engagement (three items, factor loading= 0.66), including the items “I am proud of my school” and “I feel relaxed when I interact with my teachers”; and (3) behavioral engagement (three items, factor loading = 0.54), including the items “I will actively participate in classroom discussions” and “I will take the initiative to ask questions.” The score for this scale was calculated by summing these eight items, with a higher score indicating a higher level of school engagement. The Cronbach's alpha coefficient for these items was 0.831.

Plan of Analysis

Descriptive analyses of the variables in this study were first conducted, followed by latent variable structural equation modeling (SEM) with maximum likelihood estimation using the AMOS program (version 27). Confirmatory factor analysis was first conducted to ensure that the measurement model had a good fit ( 63 ). Next, the SEM was tested with the full dataset. Cross-group SEM was applied to examine gender differences in the theoretical model. In this comparative analysis, all the factor loadings and the paths of the same model were constrained to be simultaneously equal across genders. Then, the model was tested by releasing the path constraints to determine whether releasing the equality constraint could significantly improve the fit. The model fit was evaluated using SEM incremental fit indices, including the normed fit index (NFI), comparative fit index (CFI), incremental fit index (IFI) and root mean square error of approximation (RMSEA). Typically, an NFI, CFI and IFI above 0.95 and an RMSEA below 0.06 indicate that the model fits the data well ( 64 – 66 ). A number of demographic variables were added to the model as control variables before conducting the SEM analysis. They were family economic status, father's education level and mother's education level.

Descriptive Statistics

Table 1 shows the descriptive statistics (means and standard deviations) of the study variables broken down by gender. Table 2 shows the correlations among the four variables. All the variables are positively associated with each other except two, which are both related to academic self-disclosure to parents (academic stress, r = −0.090, p < 0.01; mental distress, r = −0.194, p < 0.01). Another negative but non-significant correlation was found between mental distress and school engagement. The strongest association was found between academic stress and mental distress ( r = 0.459, p < 0.01). Two relatively strong associations were found related to school engagement (academic stress, r = 0.197, p < 0.01; academic self-disclosure to parents r = 0.238, p < 0.01).

Descriptive statistics of the research variables.




1. Academic stress	57.76 (11.19)	55.14 (11.62)	59.80 (10.41)
2. Mental distress	40.87 (16.99)	38.10 (15.56)	43.01 (17.74)
3. Academic self-disclosure to parents	14.83 (4.80)	14.59 (4.75)	15.02 (4.84)
4. School engagement	26.37 (4.88)	26.52 (4.93)	26.27 (4.93)

a On a scale: from 1 = “Strongly disagree” to 5 = “Strongly agree”.

b On a scale: from 1 = “Never” to 5 = “Very severe”.

c On a scale: from 1 = “Totally not met” to 5 = “Totally met” .

Intercorrelations between variables.


1. Academic stress	–	0.459**	—.090**	0.197**
2. Mental distress		–	−0.194**	−0.045
3. Academic self-disclosure to parents			–	0.238**
4. School engagement				–

** p <0.01 .

Overall Model

The results of the analysis based on the total sample indicated that the model was a good fit for the data [ χ ( 104 , N = 1 , 804 ) 2 = 705.757, p < 0.001, with NFI = 0.947, CFI = 0.954, IFI = 0.954, and RMSEA = 0.06].

Figure 1 shows the paths in the overall model. The three paths to the three endogenous variables were all significant: the path from academic stress to mental distress (β = 0.53, p < 0.001), the path from academic stress to academic self-disclosure to parents (β = −0.08, p < 0.001), and the path from academic stress to school engagement (β = 0.37, p < 0.001).

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Structural equation modeling of the direct effect of academic stress on mental distress, academic self-disclosure to parents and school engagement (numbers are standardized effects. *Indicates statistical significance at p < 0.01.).

Overall, the variable of academic stress accounted for 28, 5, and 15% of the explained variances in the dependent variables of mental distress ( R 2 = 0.28), academic self-disclosure ( R 2 = 0.05) and school engagement ( R 2 = 0.15), respectively.

Gender Comparison

In this analysis, the paths in the same model were constrained to be simultaneously equal in the male and female subgroups. The analysis showed that there was a good fit to the data [χ 2 (121, N: males = 789, females = 1, 012) = 719.951, p < 0.001, with NFI = 0.940, IFI = 0.950, CFI = 0.950, and RMSEA = 0.052].

Next, the model was tested to determine whether releasing the equality constraints on the paths could significantly improve the fit. After releasing path constraints one at a time, it was determined that releasing the constraint between academic stress and mental distress yielded a better fit. The result for the final model with one constraint released was as follows: χ 2 (120, N: males = 789, females = 1, 012 ) = 705.026, p < 0.001, with NFI = 0.942, IFI = 0.951, CFI = 0.951, and RMSEA = 0.052. Figure 2 presents the results of this analysis.

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Structural equation modeling of the direct effect of academic stress on males' and females' mental distress, academic self-disclosure to parents and school engagement (numbers are standardized effects. *Indicates statistical significance at p < 0.01).

Gender differences emerged in the path between academic stress and mental distress. The association between academic stress and mental distress is stronger among females (β = 0.59) than among males (β = 0.43). Finally, the overall model explained 35% of the variance in mental distress among females ( R 2 = 0.35) and 18% of the variance among males ( R 2 = 0.18). These results mean that the overall model explains mental distress better for females than for males.

This study examined how academic stress affects mental distress, academic self-disclosure to parents and school engagement among high school adolescents in Hong Kong. A comparison by gender was also performed to determine whether the theoretical model fit both genders.

As hypothesized, the results of the present study indicate that the association between academic stress and mental distress is positive and significant. This finding is consistent with previous empirical studies that suggested that students who experience academic stress are more likely to suffer from various symptoms of mental distress ( 3 , 8 , 9 , 23 ). In view of the strong correlation ( r = 0.46) between academic stress and mental distress in this study, academic stress should indeed be considered a risk factor for mental health problems in adolescents in Hong Kong. In addition, academic stress being measured in this study is referred to as stress triggered by the academic expectations of parents, teachers and adolescent themselves. To satisfy their parents' educational aspiration, teachers' academic demands, and their own scholastic desire, high-school students strive for excellence and success in academic performance, which may push them to the edge of mental distress, especially those examinations that they are facing are crucial to determine their path after high school.

In line with our hypothesis, the results of this study suggest that there is a negative and significant association ( r = 0.09) between academic stress and academic self-disclosure to parents. Specifically, a higher level of academic stress means that students are unlikely to disclose their academic situation to their parents ( 40 ). This finding supports the present theoretical framework and its integration with spillover theory and objective self-awareness theory. When high school students experience academic stress, their distress may spill over to the family system and affect communication with their parents with a decrease in self-disclosure to parents ( 16 ). This blockage of communication will prevent parents from being informed of the academic situation and the difficulties experienced by their children in a timely manner ( 42 ). These findings also provide empirical data to support the ideas suggested by objective self-awareness theory, that once students are aware of their own situation or performance, they will likely develop a negative mood when they see the discrepancy between their performance and the standard; this, in turn, will inhibit their self-disclosure, especially when they are not sure of their parents' responses ( 41 , 67 ). Moreover, non-disclosure will mean that parents remain ignorant of the academic situation their child is in, making it difficult for them to provide support and assistance in a timely manner.

In contrast to our hypothesis, the results of this study indicate that academic stress is positively associated with school engagement, i.e., the higher the level of academic stress is, the more adolescents are engaged in school. This result is contrary to most past empirical studies that concluded that there was a negative association between stress and school engagement ( 19 , 20 , 46 , 68 ). Although stress, particularly excessive stress, has detrimental impacts on the health and functioning of individuals, it may also have facilitative effects by motivating the individual to work hard or perform well in stressful situations if the stress level is still within the coping range ( 69 , 70 ). Stress related to examinations or academic issues may motivate students to further engage in school by paying more attention to their learning, putting extra effort into their schoolwork, or increasing their participation in lessons to overcome challenges. In other words, academic stress may be associated with greater school engagement if students have the desire and determination to master their academic challenges.

In addition, school engagement is usually considered a multidimensional construct that has three common components, i.e., cognitive, affective and behavioral engagement ( 71 ). However, some school personnel adopt typology to classify students based on their different types of engagement ( 72 ), including (1) engagement, (2) strategic compliance, (3) ritual compliance, (4) retreatism and (5) rebellion ( 72 ). This typology is based on the nature of and motivation behind school engagement. Based on this classification system and the three different components of school engagement, Conner suggested that there are seven categories, namely, purposeful, full, rational, busy, pleasurable, mental and recreational engagement ( 73 ). The findings indicated that most students, even those experiencing stress during high school, display busy engagement, i.e., they consistently work hard and put in effort; however, they rarely enjoy their work ( 73 ). This type of engagement is mainly driven by the belief that engagement in school is necessary and beneficial to academic success. In the present study, the positive association between academic stress and school engagement may reflect the fact that the students display this type of school engagement, i.e., busy engagement, in school to address their learning difficulties even if they are experiencing academic stress. This possible explanation of the positive association between academic stress and school engagement takes motivation into consideration, and further investigation should be conducted to substantiate this proposition.

The results of this study show that the theoretical model fit both genders, showing that academic stress predicts mental distress, academic self-disclosure to parents and school engagement. Notably, the findings of this study suggest that girls who are experiencing academic stress are more vulnerable to developing mental distress. This finding is consistent with previous studies that concluded that females are more susceptible to the detrimental effects of academic stress in terms of mental health symptoms ( 19 , 46 , 68 ).

Implications for Theories, Policies and Practices

Previous studies have suggested that factors from personal, familial and school domains trigger academic stress ( 2 , 52 , 74 , 75 ). However, relatively few studies have explored how academic stress in turn affects adolescents' interactions in their school and familial domains. Unlike most previous studies on academic stress that focused mainly on how academic stress affects individual physical and mental health, the present study explored the effects on interpersonal interactions in the family and engagement in the school system, which are two significant systems for adolescents. The findings of the present study support the current theoretical model, particularly when viewed in conjunction with spillover theory, suggesting that academic stress can spill over to other social systems and affect adolescents' interactions with significant others and their participation in the social environment ( 16 , 18 ). Nevertheless, the directions of the effect are not the same in the family and school systems. Specifically, a higher level of academic stress discourages adolescents from disclosing their academic issues to their parents but promotes their engagement in school. The associations between academic stress and self-disclosure to parents and between academic stress and school engagement may reflect the action of inhibiting and facilitating forces, respectively. Notably, the positive association between academic stress and school engagement is in contrast with the findings of most previous empirical studies ( 20 , 46 , 68 , 76 ). These contradictory findings suggest the need for further research into whether the association depends on certain psychosocial mechanisms, such as academic motivation or academic aspiration. Future research might include mediator(s) in the model to elucidate the pathway from academic stress to school engagement. In addition, the dimensions of school engagement, i.e., cognitive, affective and behavioral, could be investigated separately ( 76 ), as the antecedents and consequences of the different engagement dimensions may also vary ( 46 ).

Although mental health issues among high school students are well-surveyed in Hong Kong, whether academic stress is a possible factor that may influence the level of mental distress has seldom been investigated. This study provides empirical evidence that academic stress can have detrimental effect on individual mental wellbeing among adolescents. In view of the strong correlation between academic stress and mental distress in the present study, academic stress is an important entry point and intervention target to reduce the levels of depression, anxiety and somatization in students. Policymakers should allocate resources to launching campaigns to increase awareness of the harmful effects of academic stress. Education-related social policies should be re-examined by reviewing the curriculum, frequency of examinations and methods of assessment with the aim of reducing the level of academic stress. Different levels of school personnel, including principals, classroom teachers and school counselors, can work together to promote effective coping strategies among their students to reduce academic stress. Such multilevel collaborations can support students' psychological wellbeing in the long term. In addition, social work practitioners can organize psychosocial education on stress management or relaxation exercises for students who experience academic stress, which is a risk factor for developing depression, anxiety and somatization. Finally, although prevention and intervention programs could be provided to both boys and girls, particular attention and dedicated resources should be allocated to girls, who tend to suffer more from the undesirable effects of academic stress in terms of mental health problems.

One of the major findings of the present study is that students who experience a high level of academic stress are less likely to disclose their academic issues to their parents. Parents need to be aware of this association and should remember that they cannot always rely on their children's self-disclosure of their academic difficulties. Hence, school social workers could provide family intervention and sensitivity training to parents and suggest ways in which they can take the initiative to show their concern to their children and detect the academic struggles and stress experienced by their children. Such sensitivity and alertness can facilitate the implementation of early and proactive interventions.

Although school engagement is consistently found to be associated with positive outcomes, such as better academic achievement, positive teacher-student relationships, and higher life satisfaction ( 46 ), the positive connection between academic stress and school engagement shown in this study suggests that engagement in school should not be assumed to be an exclusively positive sign. In other words, a high level of school engagement does not imply freedom from or a low level of academic stress. Teachers and school counselors should always determine what is underlying the presence or absence of engagement rather than focusing on engagement behaviors. Is engagement related to academic stress or other factors? With this awareness, individuals who are required to help students will not overlook academic stress as an underlying factor resulting in school engagement.

Limitations

There are a few limitations of this study that should be considered when interpreting the results. First, this research was based on cross-sectional data; thus, the causal relationships among the variables cannot be ascertained. A longitudinal panel design can be adopted to investigate causality among the variables in this study. Second, our data were based exclusively on adolescents' self-reports. It is possible that the significant associations between the latent variables may be affected by shared method variance if adolescents were the sole respondents. The information collected for academic stress, mental distress, academic self-disclosure to parents and school engagement was self-reported by students, who might have exaggerated their perceptions or underreported their level of academic stress and mental distress due to social desirability bias and the sensitivity of the issue of mental health. Further studies could consider multiple informants, such as parents or teachers, to overcome the issue of shared method variance. Third, although the sample size was large, this study used a convenience sample of students in Hong Kong. Hence, the conclusions should be interpreted with caution and should not be generalized to other age groups or cultural contexts. Fourth, in view of the relatively small correlations between academic stress and academic self-disclosure to parents, the findings should be interpreted with caution. In addition, there is no analysis on how school level, as a cluster, influences the variables that were examined. Therefore, how the school may affect the association between academic stress and its associated effects, particular school engagement, is not fully understood. Finally, the data were collected during the COVID-19 pandemic, and students may encounter insecurity about schooling and public assessment, which may have affected their experiences in school and their level of academic stress. Hence, the results of this study should be interpreted with caution.

In summary, the present study provides empirical evidence of the effects of academic stress on mental distress, academic self-disclosure to parents and school engagement in Hong Kong. The findings indicate that academic stress has significant associations with all these effects. In addition, the results also reflect that the pattern of the association and effects on these three endogenous variables are similar across genders, although females who experience academic stress tend to develop more mental distress. This implies that policies and social work intervention can be applied to both genders, but more attention should be given to females experiencing academic stress.

Data Availability Statement

Ethics statement.

The studies involving human participants were reviewed and approved by the Chinese University of Hong Kong Survey and Behavioral Research Ethics. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin.

Author Contributions

EC and J-KC: conceptualization, methodology, and data analysis. EC: writing and project administration. J-KC: review—editing. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

Open access
Published: 14 June 2024

Stress-related experiences and intentions to quit studies among female married postgraduate distance education students in Ghana

Eugene Adu Henaku 1 ,
Francis Sambah 2 ,
Frank Quansah 3 ,
Edmond Kwesi Agormedah 4 ,
Medina Srem-Sai 5 ,
John Elvis Hagan Jr. 6 , 7 ,
Francis Ankomah 8 , 9 ,
Vera Rosemary Ankomah-Sey 10 &
Thomas Schack 7

BMC Psychology volume 12 , Article number: 348 ( 2024 ) Cite this article

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Although postgraduate studies have been shown to be associated with stressful experiences, students reading programmes through the distance and e-learning mode experience greater levels of stress due to several reasons. These stressful encounters might be heightened in female married postgraduates on distance education programmes due to other family-work-related engagements. This study investigated the stress-related experiences and intentions to quit studies among female married students on a distance education programme in Ghana.

Using a sequential explanatory mixed-methods design, 164 married postgraduate distance education students were sampled to participate by responding to a questionnaire. Follow-up interviews were conducted with 10 participants to offer insight into the quantitative findings. Quantitative data were analysed using descriptive statistics, including frequency and percentages, while the qualitative data were thematically analysed.

Stress was prevalent among the female married distance education students, with the majority having intentions of quitting their studies. The stressors identified ranged from personal (i.e., work and family demands) to institutional ones (i.e., academic load, unresolved complaints and high financial demands from the programme).

Conclusions

Key findings suggest that female married postgraduate distance education students perform multiple roles as full-time employees with family and academic demands that can negatively impact their health and academic work. Implications and recommendations of the findings are discussed.

Peer Review reports

Introduction

The popularity of distance learning has grown recently. Parallel to this growth, advocates for education reform, including educators, policymakers and researchers, are increasingly calling for an action in response to the psychological consequences (stress) and intention to discontinue studies (student attrition or dropout rate) in the distance education space. Although distance education students enjoy a more flexible learning environment, they nonetheless experience stress, which influences their psychological well-being and academic progress [ 1 , 2 ]. Stress in this study reflects the conceptualization provided by Lazarus and Folkman [ 3 ] as “a particular relationship between the person and the environment that is judged by the person as burdensome or exceeding his or her capacity or resources to cope with the situation at hand” (p. 19). Thus, the disproportion between demands and resources is characterized as stress [ 4 ]. More specifically, we describe “educational or academic stress as the sensation of being overburdened by school workloads or demands”.

Studies have reported that students enrolled in distance education worldwide have been shown to experience high levels of stress [ 5 , 6 , 7 ]. Given that males and females react to stress differently [ 8 ], scholars have found that female distance learners exhibit higher levels of academic stress than their male counterparts [ 9 , 10 , 11 ]. Particularly, married women enrolled in distance education programmes are also more likely than men to experience and exhibit symptoms of depression, anxiety, discomfort, and stress [ 12 , 13 ]. These stressors are linked to several internal (e.g., personal goals, expectations, standards) [ 2 , 14 ] and external stressors (e.g., excessive academic workload and assignments, time constraints, financial issues, attending to family-related responsibilities, and other social issues) [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 14 ]. Although educational stress can be beneficial because it challenges students and motivates students to succeed [ 24 ], it can also have negative effects on student learning [ 25 , 26 ], judgment and adaptive function [ 23 ] and lead to examination malpractices, and engaging in inappropriate school behaviours [ 26 , 27 , 28 ]. Stress can cause unhealthy behaviours [ 29 , 30 ] and is linked to students’ intentions to drop out of school [ 31 , 32 ].

In higher education, the intention of distance education students to quit or drop out is on the rise [ 33 , 34 , 35 , 36 ]. In this current investigation, students’ intention to quit a study is defined as “the perceived or subjective probability that a student will drop out of the programme in which they have enrolled and the frequency of having that thought”. According to earlier research reports [ 37 , 38 ], dropping out of school has a negative impact on students’ self-esteem, psychological, emotional, and social well-being. This outcome has a negative impact on learning, unemployment, and lower standard of living. Extant researchers have found that distance education students’ intention to quit studies or drop out is related to several factors, including psychological consequences such as stress and burnout symptoms [ 39 , 40 , 41 , 42 , 43 , 44 ]. Swani et al. [ 45 ] established that stress reduces students’ satisfaction and intention to stay on their programme. In Peru, it was found that most distance education students withdrew from their studies due to mental health-related reasons [ 34 , 46 , 47 ]. In Brazil, De Souza et al. [ 48 ] showed that distance education students’ dropout intention was influenced by negative affectivity (i.e., symptoms of depression, anxiety, and stress). The effect of academic stress on the intention to quit studying was attributed to several reasons, such as conflicts between study, work/employment, and family commitments [ 49 , 50 ]. The online and distance education literature points to the challenges of balancing work, study, and family responsibilities as the reasons for dropping out of a university [ 49 , 50 , 51 , 52 ].

Due to inadequate or deteriorating facilities, universities in developing economies, such as Ghana, have had to deal with the unpleasant responsibility of rejecting qualified applicants [ 53 ]. As a result, various universities use distance education as one of the most effective teaching methods to expand access to tertiary education to meet the growing demands of professional education [ 54 , 55 ]. Most educators believe that traditional on-campus education and training can be improved by distance learning. Distance education has become a way for existing and new educational establishments to admit working-class students ever since it was introduced [ 56 ]. In Ghana, for example, the majority of distance learners are adults who are married, parents, or employed (working), placing a huge demand on their learning time. Thus, these learners are likely to frequently face psychological, socio-religious, and financial/economic difficulties, as a result of creating a balance between work, school, and social lives. In fact, previous studies in Ghana have confirmed that student mothers in distance education face challenges such as the inability to regularly attend face-to-face lectures due to exhaustion, poor health of their children, and the lack of lactation rooms for breastfeeding [ 57 ]. Other findings have shown that married students were more stressed than unmarried students due to institutional, instructional, social, psychological, financial and family/marriage problems [ 54 , 58 , 59 ]. Obviously, these conflicts put a lot of pressure on these learners and negatively impact their academic performance [ 60 , 61 , 62 ].

During face-to-face interactions with female married distance students in some of the distance education campuses of one of the public universities in Ghana, they complained of headaches, lack of sleep, and fatigue due to poor educational services received from the university. Accordingly, frustrated distance learners who are unable to cope with the stress may delay on or withdraw from the academic programme, thereby squandering their investment and jeopardizing their educational goals [ 63 , 64 ]. Studies on distance education in Ghana have focused mainly on stress, struggles and coping strategies [ 54 , 57 , 62 ], challenges and coping strategies [ 59 ], satisfaction and choice of distance programme [ 53 , 60 ], students’ learning with information communication technology [ 65 ], and student mode of learning [ 66 ]. Yet issues of how these stressors manisfest and intentions to quit the programme have not been extensively investigated, especially with a unique population like female married women. Given this premise, this study examined female married postgraduate distance education students’ stress-related experiences and intention to quit studies. The current inquiry (1) explored the work-related activities of female married distance education students, (2) identified school-related perceived stressors of female married distance education students and (3) examined the intentions of female married distance education students to quit their programme. Investigating the role of educational stress on intentions to quit or drop out is especially relevant as dropout intentions may be seen as a coping mechanism in response to stress (escape-avoidance coping) [ 67 ].

Methods and materials

Study design.

The research adopted the sequential explanatory mixed-methods design, which started with a quantitative study followed by a purposeful qualitative phase based on the findings from the first stage. The use of this research design is justified because the investigators are interested in the attainment of both in-depth stress-related experiences and general realities that characterise the numerous loci of distance education students’ challenges in Ghana that research to date has marginalised [ 68 , 69 , 70 ]. Given the sparse research on this research theme across the sample, using the sequential explanatory mixed-methods approach is recognised as the most preferred design for this detailed inquiry. The subsequent sections of the methods have been structured into the quantitative and qualitative phases. The point of integration for this research is at the study design level (via explanatory sequential), method level (via the building approach) and interpretation stage (through the contiguous integration method).

Quantitative phase

Participants’ information.

The study sampled 164 female married distance education students from the University of Cape Coast (UCC), Cape Coast, Ghana. In terms of age, the youngest respondent was 23 years, whereas the oldest was 53 years old. The mean age was 35 years ( SD = 6.08), indicating that the majority of the participants were in their middle adulthood stage. The participants’ reported number of children were 0 ( n = 28, 17.1%), 1 ( n = 30, 18.3%), 2 ( n = 52, 31.7%), 3( n = 37, 22.6%), and 4 ( n = 17, 10.4%). The mean number of children was 2 with a standard deviation of 0.23. Over 90% of the respondents were Christians ( n = 150, 91.5%), with 7.3% being Muslims ( n = 12) and 1.2% being atheists ( n = 2).

Inclusion criteria

Due to the nature of the study population, the following inclusion criteria were used: (1) the student should be a registered postgraduate student in the selected institution, (2) the participant should be reading a postgraduate programme with both taught courses and research work (i.e., project work, dissertation or thesis), and (3) the participants must be of sound mind to give consent of participation.

Research instrument: Questionnaire

A questionnaire was designed and validated by the investigators for the quantitative phase of the research. The questionnaire had a number of items which were aligned with the research objectives. First, the demographic section was created, which had three items on the participants’ background information, namely, age, religion and the number of children. Other items were designed to obtain the work-related schedules of the respondents. Sample items include: What is your employment status (full-time vs. part-time vs. unemployed)? How many days do you spend at work, if you are working? How many hours do you spend at work, if you are working? Another section of the questionnaire asked participants to indicate, from a list of school-related stressors, the ones which place much burden on them. The instruction was “Rate the following school activity/activities on the extent to which they place much burden on you?” using a scale of 0 to 5, with 0 depicting no burden and 5 signifying huge burden. The options included attending lectures, engaging in individual or group presentations, presenting/submitting term papers, writing quizzes and exams and carrying out mandatory research work (e.g., dissertation, thesis). The last question was, “How often do you feel stressed by the activities of this programme?”. The items were developed based on extensive literature review related to the field of stress and distance education [ 49 , 50 , 54 , 57 , 62 ]. The questionnaire was developed adhering to the BRUSO approach (Brief, Relevant, Unambiguous, Specific and Objective) as have been adopted and utilised in previous studies [ 71 ]. Further, the content validity of the questionnaire was also established by experts in the fields of research methodology, clinical and health psychology, distance education, and quantitative psychology. The review comments, suggestions and recommendations were incorporated to improve the quality of the instrument [ 72 ]. As a preliminary check, five female married distance education students were identified and the questionnaire was administered to them. After the administration, their inputs concerning the clarity and understanding of the items were provided, which further shaped the items and the questionnaire.

Data collection procedures

All participants who identified themselves as satisfying all the inclusion criteria were contacted to participate in the study. Whereas some participants opted for an online version of the questionnaire (which was sent to their emails using Google forms), others preferred hard copies which were administered to them in class. The participants were assured of confidentiality, anonymity and volition, and consent was obtained through signing a consent form. After the questionnaire administration, the participants were asked to optionally indicate whether they would be willing to participate in the second phase (i.e., qualitative component) of the research. Those who gave such consent were required to provide other personal contact details on their questionnaire. About 44.5% ( n = 73) of them indicated their willingness to participate in the qualitative phase of the research. Ethical approval was sought from the Institutional Review Board of the University of Cape Coast, Ghana, with reference number UCCIRB/EXT/2020/25.

Quantitative data analysis

The data retrieved from the participants were screened for data entry errors. All inconsistent data were removed from the dataset. The quantitative data were analysed using descriptive statistics, including frequency, percentage, mean, standard deviation, and correlational analysis. Bar and pie graphs were used to represent some portions of the data to address the objectives. More precisely, the frequency counts and percentage of the responses were computed on a number of work-related activities (e.g., number of days, how many hours of work, working full time, part-time or unemployed) in order to address research objective one. For research objective two, responses on the various stressors encountered by the female distance education students were summarised using mean and standard deviation. Whereas a correlational analysis was perfomed to examine the association among the identified stressors, frequency counts were used to assess the degree of stress they encountered; these are additional analyses to address the second objective. Data on the last research objective was analysed using frequency and percentage counts to tally the responses provided on the students’ intentions to quit their programme.

Qualitative phase

The qualitative phase was drawn from the face-to-face interview and phone interview data collected from participants who opted to be part of the second phase of the research. This follow-up interview was necessary based on the following objectives: (1) to explain why most participants experienced stress, and (2) reasons for their intentions to quit the postgraduate programme, as shown in the first phase of the study.

Participants’ selection

The study purposefully selected individuals who opted to be part of the second phase. Although 73 participants opted to be part, we could not reach 30 of the participants through the contact information they provided. Out of the remaining 43, 11 of them had earlier indicated that they had not been stressed and had never thought of quitting the programme. Based on data saturation, we interviewed 10 out of the 32 participants who were available and willing to be interviewed face-to-face or via phone due to distance. It must be noted that all 32 had mentioned in the quantitative phase that they were experiencing stress and as well had intentions of quitting the programme.

Research instrument: Interview guide

A semi-structured interview guide was used to gather data from participants during the second phase of the study. Per the nature of the research design, the interview guide was carefully developed by the investigators based on the outcome of the quantitative phase of the research. The instrument focused on understanding participants’ stress and thoughts of quitting the programme as a follow-up on the initial survey. The interview questions bothered on getting in-depth information about the stress and stressors encountered in their schooling. The interview guide was first independently validated by experts in the fields of research methodology, clinical and health psychology, distance education, and educational psychology. Secondly, these experts together with the investigators had extensive discussion on the developed interview guide, afterwhich modifications were made accordingly.

Before the interview, participants were contacted and informed about the interviews. The participants and the researchers discussed and scheduled the date and time for the interviews, prioritising participants’ convenience to ensure their maximum cooperation and participation. Due to the difficulties of physical location of the homes of the study participants most ( n = 7) of the participants were interviewed via phone based on preference, while the remaining ( n = 3) were interviewed face-to-face. Participants consented to be interviewed and audiotaped by signing a consent form sent via WhatsApp and email to participants who were interviewed via phone. A hard copy of the consent form was made available for participants who were interviewed face-to-face to sign.

Qualitative data analysis

Transcripts were coded and thematically analysed using both manual and computer-assisted qualitative data analysis. To address the qualitative research objectives, a thematic analysis was carried out using the MAXQDA qualitative software for coding and development of themes. The qualitative data collected was first transcribed verbatim [ 73 ]. We read through the entire data to familiarise ourselves with the data, after which important sections were coded [ 74 ]. Initially, 84 codes were developed. These codes were then organised into two major themes [ 74 ]. The first major theme had five sub-themes, while the second major theme has two sub-themes (See Table 1 ). To ensure the trustworthiness of the qualitative results, the results were sent to participants to check the accuracy of the results regarding their experiences [ 75 , 76 ]. Participants’ feedback did not have any significant influence on our findings. Students experiencing stress, as indicated in the quantitative phase, were involved in the qualitative phase to ensure the transferability of the findings to a similar population. Pseudonyms were also used to anonymise the identity of the participants.

Quantitative results

Work-related activities of female married distance education students.

Three indicators were examined to understand the work activities of the participants. These indicators were the employment status of the participants, the number of days of working (if they are employed) and the number of hours they worked. The details of the analysis are shown in Table 2 .

A greater percentage of the participants were employed in full-time jobs (86%), with less than 10% working as part-time workers (9.8%) (see Table 2 ). Very few participants were unemployed ( n = 7, 4.3%). The majority of the students worked 5 days a week ( n = 128, 78%). Others reported working 6 days ( n = 14, 8.5%) and 7 days ( n = 15, 9.1%) within the week. Concerning the number of hours, it was revealed that most of the participants worked 8 h or more within the day. For example, 48.8% worked for 8 h, 15.2% worked for 9 h and 15.2% again worked for 10 h. Some also reported working for 11 h (1.8%) and 12 h (7.3%) in a day.

School-related perceived stressors on female married distance education students

The study examined 5 main school-related perceived stressors of postgraduate studies and attempted to understand which of them placed much stress on them. The study also explored how burdens on a particular school activity could spill over to other related activities. The results are shown in Table 3 .

As shown in Table 3 , it was discovered that conducting research work placed the highest stress on the students ( M = 3.49, SD = 1.41), followed by writing examinations ( M = 2.74, SD = 1.51) and attending lectures ( M = 2.48, SD = 1.50). Producing term papers and doing individual or group presentations in class were considered the least in terms of stress. Further results also showed significant positive relationships among the school activities regarding the associated stressful ratings. In particular, the relationship coefficients ranged from 0.173 to 0.529, suggesting that when there is a higher stress level associated with any of the activities, it is likely that other activities would also place a huge burden on the students.

The respondents were also asked to indicate how stressful they felt being on the programme. As depicted in Fig. 1 , it was revealed that about two-thirds of the female married distance education students felt much stressed (66.5%). Other participants also reported being moderately stressed (25.6%) and only 4.3% of them indicated less stressed. About 3.7% of the participants mentioned that they were not stressed at all.

Degree of stress encountered on the postgraduate programme

Intentions of female married DE students to quit their programme

The study also sought to assess respondents’ intentions to terminate their postgraduate studies due to its stressful nature and other associated factors. The graphical analysis as depicted in Fig. 2 showed that about 21% of the students had intentions to quit the programme, at all time ( n = 35). Furthermore, a larger proportion of the students reiterated that they sometimes have thoughts of quitting their postgraduate studies ( n = 85, 52%). However, some students reported that they had never thought of quitting the programme ( n = 44, 27%).

Intentions to quit postgraduate studies

Qualitative results

Participants’ views and explanation of themes.

Distance education allows students and teachers flexibility regarding place, time and pace of learning [ 54 , 77 ]. Distance education students/learners choose not to attend the traditional classroom or face-to-face schooling for several reasons, such as time constraints, geography, family demands and work requirements [ 78 ]. In turn, students have the advantage of deciding their learning. This suggests that distance education’s flexibility will reduce stress (distress). However, this was not the case for the study participants. Instead, the themes that emerged from the data show that most participants experienced stress. Hence, participants thought of quitting the programme. Two major themes and five sub-themes were generated after coding and categorisation of the codes. These themes and sub-themes are presented in Table 1 .

Institutional/administrative stressors

Inconsistent schedules, academic workload, unresolved complaints, financial strain and discouragement, were the primary sources of the institutional/administrative stressors which made the study participants think of quitting the programme. In addition, participants spoke about how they are stressed due to the administrative activities of the distance education programme.

Inconsistent schedules

Participants explained that their thoughts of quitting the programme emanate from the stress they experience due to inconsistent schedules and postponement of activities such as the distribution of course materials, quizzes and examinations. Some participants said:

“…it is much stress when you prepare for an examination and just a day before the examination it is postponed…” (Keziah).

“…they [ referring to the University management ] are not consistent with the timetable they give us; they keep changing and that stresses me because it makes me keep changing my schedules at work …” (Hannah).

Another participant illustrated how students are stressed:

“The organisation of the school and the way of distributing modules [referring to reading materials] is appalling because it prevents us from studying since we don’t have the modules only to receive a module a week before the exam”. (Anita)

Unresolved complaints

Consumers expect that when they express their dissatisfaction about products, services or staffs of an organisation or institution, it would be acknowledged and the necessary actions carried out to ensure their satisfaction or grievances addressed. This makes the organisation or institution accountable to the public, improving its reputation and strengthening public confidence [ 79 ]. However, the findings of this study show that students’ complaints were unresolved. The participants explained that the unresolved complaint stresses them, so they thought of quitting the programme. Some participants expressed:

“Sometimes, if you have a problem, you complain several times, but it wouldn’t be solved until you go to the main campus.” (Keziah).

Another participant added that

“…also, some papers haven’t appeared on my results slip [transcript], and getting help to resolve it has taken me a year, but still it has not been resolved, and in fact, it frustrates me…” (Rebecca).

Academic workload

Most of the participants in this study reported being stressed due to the academic workload. They explained that many topics are taught within a day, so they have to spend much time reading their course materials. In addition, the participants explained that they are also given several assignments to complete, which adds to their workload. The following are extracts from the participants’ interviews:

“Yes, I once thought of stopping because of the workload. Sometimes, many different topics are taught on the same day, and I have three or more assignments to do at a time which I have little time for…” (Hannah).

“…I am thinking of stopping because the workload is too much for me to handle. We are given too many assignments.” (Rebecca).

The findings of this study imply that the distance education students involved in this study need much time to meet their academic demands. Hence, if a student enrolled on a distance education programme because of time constrain, as it has been identified by some studies [ 7 , 80 ] as one of the reasons why some individuals opt for distance education/learning, then it is likely that those individuals might put their thought of quitting the programme into action.

Financial strain

Financial strain was an issue of concern to some participants. The participants explained that stress resulting from financial difficulties fuels their intentions to quit the programme. They complained of expensive tuition fees and limited time of payment. According to some participants:

“Another reason is that the school fees [tuition fees] is too much [expensive] as compared to other institutions that offer a similar programme.” (Bridgit). “Also, the amount of fees is expensive and the duration to make payment before our courses are registered is too short for raising that amount to pay the fees” (Leticia).

Discouragement

Many students hope to secure better employment or be promoted in their careers or work after graduation. In this study, most of the participants are workers seeking to upgrade themselves or enhancing their professional development but have to opt for distance education due to work schedules. However, a participant shared her concerns about how some teachers discourage them. She explained that some lecturers retort that they would not be upgraded because her degree was obtained through distance education. She said:

“You know, most of us are teachers and want to upgrade, but it’s too stressful and it hurt to hear some of our teachers saying that after the distance programme, it won’t send you anywhere using your certificate…” (Anna).

Personal stressors

An advantage of distance education/learning is the flexibility of time and the opportunity for students to plan their learning and complete their academic courses at their own pace [ 81 ]. Therefore individuals who are not able to attend traditional face-to-face school due to but not limited to, work, financial, geographic, family and time constraints usually opt for distance education so that they can achieve their academic goals without interfering with or disrupting their personal everyday life [ 81 ]. However, our analysis revealed that work/employment and family demands (sub-themes) were the personal stressors that made participants consider quitting the programme.

Work/employment

Strain resulting from work/employment was a significant personal stressor, according to most of the participants. During our interview, most participants explained that they had thought of quitting their programme because combining work and academics was challenging since both require time and attention. They added that sometimes they have to be at work, and at the same time, they have to be at lectures. A participant illustrated how the combination of her work and academic work stresses her:

“ I am a worker; throughout the week, I am at work and leave (close from work) around 6 pm or even beyond. Therefore, sometimes it is not easy to get time to learn. Also, sometimes deadlines given for the submission of assignments are very short, putting us under a lot of pressure and stress. For that reason, it occurred to me once to quit. But I still gathered the strength to go on. (Leticia)

Some participants added:

“It is stressful combining examinations, projects, presentations, assignments, quizzes, managing my family, monetary issues, and online lectures…” Sometimes I feel I should just give up.” (Dorine).

A participant also said:

“I have no time at all; every day, I am busy. I go to work from Monday to Friday and sometimes close very late and tired, so I am not able to study…” (Anna).

Family demands

Participants explained that combining family demands such as cooking and taking care of children with academic work such as completing assignments and attending lectures is strenuous, so sometimes, they are tempted to quit studies. A participant illustrated how the need to meet her family demands and academic work stresses her:

“…also, I have to take care of the family and make sure our home is in order. So, it is very stressful to do all of these and assignments, prepare for quizzes and examinations.” (Anna).

Another participant said:

“I have thoughts of stopping because I hardly get someone to take care of my kids on Saturdays as my husband, too, is a health professional who goes to work on Saturdays. Travelling from my place of residence to Ho [the capital of the Volta Region where the study centre is located] along with my little children, is stressful” (Gloria).

Another participant, who looked frustrated, said

“Sometimes, I want to quit because of family pressure, especially when I am learning. ” (Bridgit).

The current inquiry investigated the work-related activities of female married distance education students, identify school-related perceived stressors of female married distance education students and examine their intentions to quit their programme. The findings indicate that the majority of the female married postgraduate students were full-time workers, with many working five days a week and eight hours a day. Additionally, the study findings showed that most of the students reported that conducting research imposes a higher burden of stress with the least reported stressors been term papers and individual/group presentations. Further, the research findings revealed that the majority of the students sometimes thought of quitting their postgraduate studies with few indicating they never thought of quitting the programme. The findings in this study are novel as it provides a qualitative perspective to help deepen the understanding of stress-related experiences of postgraduate students in the distance education programme. The general implication of these findings is that participants who enrolled on the distance education programme enjoy the benefit it offers about time flexibility [ 54 , 78 , 80 ], however, in meeting family demands, they become disappointed at a point of their studies. This latter outcome is a result of the possible effect of stress arising from the various demands (i.e., academic, work and family management) that impose a psychological burden that affects one’s quality of life. This result may therefore lead to attrition from the programme, poor academic performance, suicidal ideation, role conflict, decreased intrinsic motivation and many more negative tendencies. For instance, the findings showed that the majority of the students were in full-time employment, working five days a week and eight hours a day. This work-related engagement, when combined with academic demands, more so at the postgraduate level, may manifest negative physical, psychological and academic impacts [ 59 , 82 ]. Though related studies are rare to contrast, one analogous study found increased working hours and days to be associated with stress [ 83 ], which was also confirmed in the qualitative finding. Moreover, most female postgraduate distance education students have family-related responsibilities, such as nursing babies, which further compound their academic challenges. Plausibly, this observation could be the reason majority of the participants reported their intentions of quitting the programme. This argument is buttressed by qualitative findings, where the participants reiterated the stressful demand of caring for the family as an impediment to their academic progression. Alabi et al. [ 83 ] argued that the socio-cultural discrimination against women in Africa challenges their higher academic achievements. Since married women are entirely saddled with family care responsibilities which have a competing interest against their higher academic demands, therefore, these demands compel most women not to pursue higher education. These women opt for programmes like distance education just to be available at home to take care of the family, which comes with stressful demands [ 84 ].

Invariably, the findings revealed that most participants sometimes have thoughts of quitting their postgraduate education, with few indicating never thought of quitting the programme. This outcome means that the students may have reached a mental state of distress due to dissipated intrinsic and extrinsic motivated factors and poor system support either from the school, workplace and family support systems. By providing interventions that have proved to reduce stress and improve coping mechanisms and stress management, educational institutions can attempt to reduce the academic-related stress experienced by students. Also, extant literature has shown that educational programmes that increase students’ stress-coping abilities and skills directly and favourably affect academic achievement and reduce health risks [ 85 , 86 , 87 ]. For instance, a meta-analysis of 19 randomised controlled trials or quasi-experimental research discovered that student coping abilities were enhanced and stress symptoms were reduced by school programmes aimed at stress management [ 88 ]. A similar study in South Africa upheld the findings of the present study. For example, Silinda and Brubacher [ 89 ] found that postgraduate students in distance education programmes considered quitting the programme due to the accompanying overbearing stress and lack of support to mitigate challenges. The similarity in the finding may be due to the cross-cultural nature of academic-related stress issues. That notwithstanding, few students in the present study indicated no intention to quit the programme, which is a positive sign of resilience and noteworthy for further investigation in future research to find out their motivation. This outcome supports the assertion of Beccaria et al. [ 90 ] that these few students may be actively engaging in protective or resilience strategies to cope with their stressors, a situation worthy of emulation by others. Therefore, academic institutions running distance education programmes are encouraged to design and implement policies as well as active coping interventions that are learner-specific since individual students have different skills and motivation levels.

In furtherance, the findings also showed that most students reported that conducting research imposes a higher burden of stress with the least reported stressors being term papers and individual/group presentations. This result concurs with Silinda et al.’s [ 91 ] findings, where distance education students reported that dissertation and thesis writing imposes higher stress on them. The qualitative findings of Silinda and co’s study identified uncertainty about the research/writing process along with insufficient support from supervisors as their stressors and the reason for their intention to quit the programme. This link was confirmed in the qualitative aspect of the present study, where participants intimated institutional stressors such as inconsistent schedules, academic workload, unresolved complaints, and financial strain as precursors for their stress and intentions to abrogate their various programmes. These findings revealed the lack of or inadequate student support systems within the distance education programme of postgraduate education in Ghana. Besides, even if these support systems are available, they may not be effective in ameliorating the academic stress of students and need to be reviewed. This situation has been advocated for by the international “Healthy Universities” movement, which promotes the university’s role as a resource for promoting health and well-being among students, faculty, and the general society through instruction, research, information exchange, and institutional practice and not just strictly academics to the neglect of the students’ well-being [ 89 ].

The findings imply that institutions offering postgraduate distance learning programmes in Ghana should aid their students by providing training or counselling services that would cater for the needs of the distance learners, such as how to balance academic work with family and employment duties through integrated planning. Other implications include enhancing supervisors’ support of distance learning postgraduate students, such as through better communication, faster feedback delivery, and clearer correspondence, to help ensure that these students receive the guidance they need when writing their dissertation or thesis.

Strengths and limitations

The study’s relevance and strengths are bolstered using a two-prong mixed-methods perspective of evidence gathering to deepen and broaden understanding of the stress-related phenomena. Despite the study’s advantages, a few restrictions must be highlighted. First, it is structured as a cross-sectional design that examines the real world at a certain period. Such a strategy does not investigate longitudinal variations in perceived stressors across time. Also, we cannot completely rule out information bias because the data were gathered via self-administered questionnaires and/or devices. However, non of these limitations invalidate the findings of the study.

Conclusion and recommendations

This study investigated work-related activities of female married distance education students, identified school-related perceived stressors of female married distance education students and examined the intentions of female married distance education students to quit their programme. It can be concluded from this study that female postgraduate distance education students perform multiple roles as full-time employees with family and academic demands that can have a negative health and academic impact. Also, the majority of female postgraduate distance education students have a high propensity to quit their studies due to a lack of support from both academics and family. Lastly, conducting research imposes a high burden of stress on the participants compared to other academic-related activities.

Therefore, postgraduate distance learning students are encouraged to focus more on using active or functional coping strategies (e.g., integrated planning) rather than adopting behavioural disengagement. Active coping will assist distance learners to better initiate forearmed preparations for similar situations in the future and acquire relevant abilities to manage potential stressors. Also, orientation programmes on active coping methods offered by educational institutions and employers will be highly beneficial in helping distant learners achieve this aim. It is also advised that educational institutions provide academic counsellors to distant learners. These counsellors will advise distant learners on how to handle or manage their difficulties while pursuing their academic goals.

Data availability

Anonymized data is available upon reasonable request through the corresponding author.

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Acknowledgements

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Open Access funding enabled and organized by Projekt DEAL. The study received no external funding. However, the authors sincerely thank Bielefeld University, Germany for providing financial support through the Institutional Open Access Publication Fund for the article processing charge (APC).

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E.A.H. F.Q., and J.E.H. conceived the idea. E.A.H. and F.Q. performed the analysis. E.A.H., F.S., F.Q., E.K.A., M.S.S., J.E.H., F.A., V.A.S., and T.S. prepared the initial draft of the manuscript. All authors thoroughly revised and approved the final version of the manuscript.

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Adu Henaku, E., Sambah, F., Quansah, F. et al. Stress-related experiences and intentions to quit studies among female married postgraduate distance education students in Ghana. BMC Psychol 12 , 348 (2024). https://doi.org/10.1186/s40359-024-01839-x

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PTSD Has Surged Among College Students

The prevalence of post-traumatic stress disorder among college students rose to 7.5 percent in 2022, more than double the rate five years earlier, researchers found.

A view of a campus quad with a student walking along a path wearing a face mask. A flag at half-mast and a white tent are in the background.

By Ellen Barry

Post-traumatic stress disorder diagnoses among college students more than doubled between 2017 and 2022, climbing most sharply as the coronavirus pandemic shut down campuses and upended young adults’ lives, according to new research published on Thursday.

The prevalence of PTSD rose to 7.5 percent from 3.4 percent during that period, according to the findings . Researchers analyzed responses from more than 390,000 participants in the Healthy Minds Study, an annual web-based survey.

“The magnitude of this rise is indeed shocking,” said Yusen Zhai, the paper’s lead author, who heads the community counseling clinic at the University of Alabama at Birmingham. His clinic had seen more young people struggling in the aftermath of traumatic events. So he expected an increase, but not such a large one.

Dr. Zhai, an assistant professor in the Department of Human Studies, attributed the rise to “broader societal stressors” on college students, such as campus shootings, social unrest and the sudden loss of loved ones from the coronavirus.

PTSD is a mental health disorder characterized by intrusive thoughts, flashbacks and heightened sensitivity to reminders of an event, continuing more than a month after it occurs.

It is a relatively common disorder , with an estimated 5 percent of adults in the United States experiencing it in any given year, according to the most recent epidemiological survey conducted by the Department of Health and Human Services. Lifetime prevalence is 8 percent in women and 4 percent in men, the survey found.

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Art as a Tool for Emotional Expression and Mental Health in Schools

Jun 18, 2024
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For many centuries, art has been a method for expressing emotions and healing. People have long used it to share their feelings, narrate stories, and work through experiences. Today, this tradition continues in many forms. Schools now recognize the importance of creativity in their curriculums. This shift is not just about creativity. It’s also about addressing students' mental health. Incorporating creativity in education provides a non-verbal outlet for emotions. This helps children express what they might not say in words.

In schools, it plays a key role in supporting emotional well-being. Art and emotional expression are closely connected. Drawing and painting gives people a safe space to explore their feelings. This practice can greatly impact mental health. It makes schools more supportive environments. By using art therapy in schools, educators help students manage stress and anxiety. This approach helps people understand and express their emotions. It leads to improved mental health. This article will explore how art can be a tool for emotional expression and mental health in schools.

The Role of Art in Emotional Expression

School education includes many different subjects. Students often struggle with this stress. The importance of good grades keeps increasing. This is because they are essential for higher education. Key forms of assessment are tests and essays. These require focus and constant attention. Luckily, there is an online writing service that helps with writing. Experts in education find professional writers. They complete assignments by EduBirdie , reducing the load on students. Art therapy is also vital because people can improve mental health through art. It helps balance the workload and delegate tasks. This allows students to focus on what matters most for their future.

With creativity people express emotions they can't say. Various forms aid this process. Here’s how different forms help:

● Painting: This helps children show their feelings with colors. It reduces stress and anxiety.

● Drawing: This allows kids to depict their experiences visually. It provides a sense of relief.

● Sculpting: This form engages touch and creativity. It helps in expressing complex emotions.

● Music: Playing instruments or singing can soothe the mind. It lowers anxiety levels.

● Drama: Acting out stories helps kids understand their feelings. It boosts self-confidence.

It’s a crucial part of art education and mental health. By expressing emotions through creating, students manage stress better. This leads to a healthier school environment.

Implementing Art Programs in Schools

Schools can integrate art into their programs in many ways. Dedicated art therapy sessions help students express their emotions. For example, Bates Middle School used art integration to improve academic success and reduce disciplinary issues. Students who participated in these programs showed better engagement and understanding of their subjects.

Art can be woven into existing subjects

At the Integrated Arts Academy, teachers integrate it into science, math, and social studies. This approach helps people grasp complex concepts. For instance, in a science lesson on leaf classification, students created realistic and abstract drawings of leaves. This method improved their observation skills and understanding of forms.

After-school art clubs

These clubs provide a relaxed environment for students to explore different art forms. At Cashman Elementary, the introduction of after-school creativity programs boosted student participation and enhanced their emotional well-being. This approach helped students feel more connected and supported.

Incorporating art therapy

Programs like Creative Courage offer support groups where people can draw, play or sing. These groups help people deal with mental health issues by providing a safe space to express emotions. Art therapy in schools initiative has been successful in reducing anxiety and improving overall student well-being.

Using this strategy in schools supports emotional well-being with art. It helps students manage stress and fosters a supportive environment. Schools that have adopted these programs report significant improvements in both academic and emotional aspects of student life. This holistic approach benefits students, making learning more enjoyable.

Case Studies and Real-life Examples

Such programs in schools have shown many benefits for students. One example is the Creative Courage program . This helps students with mental health issues. It gives them a safe place to express and manage emotions. The program uses art therapy to support emotional well-being. It reduces anxiety and depression among students.

Studies show that art education can lead to better grades. Students in these programs are five times less likely to drop out of school. They also score higher on standardized tests. Those with four years of such education score over 150 points higher on the SAT compared to those with only a half-year.

In Houston, the Arts Access Initiative was implemented in 42 schools. This program provided many activities throughout the school year. The results were positive. Students showed better academic performance. They also had higher engagement levels. Schools saw a big increase in funding for creative education.

The Turnaround Arts program is another great example. This program helps schools in high-poverty areas increase mental health through art. It uses these expressions to improve school culture and student outcomes. At Savoy Elementary in Washington, D.C., students' math proficiency increased by 22% after the program started. Reading scores also improved a lot. The school saw fewer disciplinary issues and higher attendance rates.

These examples show how creative programs help students. They boost art and emotional expression and improve academic and emotional well-being. Schools that use these programs create a better environment for students. This leads to better outcomes in both education and mental health

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Mental Health

Poor Mental Health Impacts Adolescent Well-being

Key Takeaways

The number of adolescents reporting poor mental health is increasing.
Building strong bonds and connecting to youth can protect their mental health.
School staff and families can create protective relationships with students and help them grow into healthy adulthood.

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Promoting Mental Health and Well-Being in Schools: An Action Guide for School Administrators and Leaders

Learn about school-based strategies and approaches to support student mental health.

Adolescent Mental Health Continues to Worsen

CDC’s Youth Risk Behavior Surveillance Data Summary & Trends Report: 2011-2021 [PDF – 10 MB] highlights concerning trends about the mental health of U.S. high school students.

In 2021, more than 4 in 10 (42%) students felt persistently sad or hopeless and nearly one-third (29%) experienced poor mental health.
In 2021, more than 1 in 5 (22%) students seriously considered attempting suicide and 1 in 10 (10%) attempted suicide.

These data bring into focus the level of distress many students are experiencing.

Some groups are more affected than others.

Young diverse people having fun at LGBT pride parade

These feelings of distress were found to be more common among LGBQ+ students, female students, and students across racial and ethnic groups.

Nearly half (45%) of LGBQ+ students in 2021 seriously considered attempting suicide—far more than heterosexual students.
Black students were more likely to attempt suicide than students of other races and ethnicities.
Youth Mental Health: The Numbers

Why Is This a Big Deal?

Poor mental health in adolescence is more than feeling blue. It can impact many areas of a teen’s life.

Youth with poor mental health may struggle with school and grades , decision making, and their health.

Mental health problems in youth often go hand-in-hand with other health and behavioral risks like increased risk of drug use , experiencing violence , and higher risk sexual behaviors that can lead to HIV, STDs, and unintended pregnancy.

Because many health behaviors and habits are established in adolescence that will carry over into adult years, it is very important to help youth develop good mental health.

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The Good News

The good news is that teens are resilient, and we know what works to support their mental health: feeling connected to school and family .

Fortunately, the same prevention strategies that promote mental health—like helping students feel connected to school/family—help prevent a range of negative experiences, like drug use and violence.
Building strong bonds and relationships with adults and friends at school, at home and in the community provides youth with a sense of connectedness.
This feeling of connectedness is important and can protect adolescents from poor mental health, and other risks like drug use and violence.
Youth need to know someone cares about them. Connections can be made virtually or in person.

There is a Role for Everyone in Supporting Teen Mental Health

As we’ve learned nationally during the COVID-19 pandemic , schools are critical in our communities to supporting children and families. While the expectation is that schools provide education, they also provide opportunities for youth to engage in physical activity and academic, social, mental health, and physical health services, all of which can relieve stress and help protect against negative outcomes.

However, the pandemic disrupted many school-based services, increasing the burden on parents, increasing stress on families, and potentially affecting long-term health outcomes for parents and children alike, especially among families already at risk for negative health outcomes from social and environmental factors.

Support is needed to mitigate these negative outcomes and lessen educational and health disparities.

Critical supports and services need to be comprehensive and community wide and should include:

What schools can do:.

Implement strategies and approaches that can help prevent mental health problems and promote positive behavioral and mental health of students.
Help students cope with emergencies and their aftermath.
Linking students to mental health services.
Integrating social emotional learning.
Training staff.
Supporting staff mental health.
Reviewing discipline policies to ensure equity.
Building safe and supportive environments.

What parents and families can do:

Communicate openly and honestly, including about their values.
Supervise their adolescent to facilitate healthy decision-making.
Spend time with their adolescent enjoying shared activities.
Become engaged in school activities and help with homework.
Volunteer at their adolescent’s school.
Communicate regularly with teachers and administrators.

What healthcare providers can do:

Ask adolescents about family relationships and school experiences as a part of routine health screenings.
Encourage positive parenting practices .
Engage parents in discussions about how to connect with their adolescents, communicate effectively, and monitor activities and health behaviors.
Educate parents and youth about adolescent development and health risks.

More Information

Parents and families may find the following resources helpful to support the mental and emotional well-being of their adolescents:

CDC Children’s Mental Health
CDC Mental Health
School Connectedness
Social Connection
Teen Mental Health
Resources for Coping After Emergencies
School-Based Physical Activity Improves the Social and Emotional Climate for Learning
School Nutrition and the Social and Emotional Climate and Learning

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Home — Essay Samples — Nursing & Health — Stress — Informative Speech Outline on Stress

Informative Speech Outline on Stress

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Introduction, body paragraph 1: causes of stress, body paragraph 2: effects of stress, body paragraph 3: management strategies.

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Saint Michael’s students kick off on-campus research projects for summer 2024

On Tuesday, June 4, students and professors gathered in the Roy Room to offer some insight into their summer research projects. From student-athlete mental health and historical beliefs about crime to immunoprecipitation and environmental paleolimnology, students are performing important research on a variety of topics and questions facing the world today.

Many of the projects are funded by grants from the Vice President for Academic Affairs Office, while some are funded through outside grants, including through the Vermont Biomedical Research Network. Students and their faculty mentors apply for the grant funding and work together throughout the summer to complete the research. Each student will present their research findings during the upcoming academic year.

Below are descriptions of each research project happening on campus during the summer of 2024.

“How does Farm Consolidation around the United States impact Climate Change?”

Benjamin Riggs ’26

Major: Business Administration

Mentor: Professor Patrick Walsh (Economics)

Riggs is conducting research on farm consolidation around the U.S., exploring how it impacts climate change. Over eight weeks, Riggs will compare data on water use and the number and size of farms, analyzing the environmental impacts of farming as the country shifted from small farming practices to sizable commercial farming. Riggs aims to find conclusions on whether farm consolidation across the U.S. has led to increased water use per acre and the environmental impacts this may have on climate change.

Elsa Gordon ’27 explains her summer research project during a research kickoff event on June 4, 2024. (Photo by Cat Cutillo/Saint Michael’s College)

Research collaboration with UVM SOCKS

Elsa Gordon ’27

Majors: Data Science and Environmental Studies

Mentor: Professor Candas Pinar (Sociology)

In collaboration with research done by the University of Vermont SOCKS (The Science of Online Corpora, Knowledge, and Stories), Gordon will gather and analyze text data from different sources, including Governor Phil Scott’s press conferences, and Vermont-specific Twitter and Reddit data. “The SOCKS team has developed a set of computational tools to measure the sentiment and stories across a diverse pool of written texts,” Gordon said. Through these tools and other qualitative research methods, Gordon aims to measure Vermonters’ sense of community or connectedness during the COVID-19 pandemic.

Innovative ways to measure blue-green algae

Shannah Weller ’27

Major: Biology, minor in Physics

Mentor: Professor Clay Williams (Environmental Studies and Science)

Professor Williams has designed a machine that will help monitor blue-green algae levels in nearby bodies of water. In collaboration with the University of Vermont, Weller will be part of the construction of some parts of this machine over the summer, along with collecting samples at five different Lake Champlain sites. In the end, Williams and Weller want to find a better way to spot the signs of blue-green algae blooms before they are dangerous to the public. “Green algae produces toxins, and is often the cause of beach closures over the summer months, posing a risk for people, pets, and more,” Weller said. “The goal is to make a more efficient, affordable, and 24/7 way to monitor blue-green algae levels because as of now, it is mostly done through volunteer efforts.”

Alexa Roux ’26 explains her summer research project with Professor Clay Williams during a summer research kickoff event on June 4, 2024. (Photo by Cat Cutillo/Saint Michael’s College)

“Environmental Paleolimnology in Saint Michael’s Natural Area Waterbodies”

Alexa Roux ’26

Majors: Chemistry and Environmental Science

Through testing of four freshwater bodies in the natural area, Roux’s research will use paleo-ecotoxicology to determine how past anthropogenic contamination in the aquatic sediment influences the current water quality. “Because natural freshwater bodies are often at the lowest point of elevation, all of the man-made contaminants run through flooding and precipitation into these lakes. These contaminants build up in layers, which can be indicators of the lake’s health,” Roux said. Roux will compare the current state of the water to the historical record of its sediment.

“Can Geographical Informational Systems (GIS) Enabled Mapping Accelerate Organic Farm Certification?”

Preston Hewett ‘25

Major: Environmental Science

In collaboration with the Northeast Organic Farming Association of VT (NOFA-VT), Hewett will be transforming paper maps into interactive maps using geographical informational systems. The goal is to make the maps more accurate, spatially aware, and dynamic. “My personal goal is to further grow these organic operations, because even though it is more expensive than conventional farming, it is a better, sustainable way to go in the future,” Hewett said. This research will test the feasibility in using dynamic maps during federal organic farm inspections, lessening the time taken to verify organic production practices.

View photos of the summer research kickoff event by Cat Cutillo, below:

“The Politics of Climate Change and Human Migration”

Olivia Francisco ‘25

Majors: Environmental Studies and Political Science

Mentor: Professor Shefali Misra (Political Science)

Francisco will investigate how climate change has had an impact on political stability and international relations through human migration patterns in Central and Eastern Africa. Francisco plans to analyze quantitative and content migration data, in addition to political discourse on environmental migration. This study aims to give insight into how vulnerable populations are affected by displacement in the context of climate change-related crises.

Colby Fane-Cushing ’25 describes his ongoing research that he plans to continue during the summer of 2024 during a research kickoff event on June 4, 2024. (Photo by Cat Cutillo/Saint Michael’s College)

Studying stress in student-athletes

Colby Fane-Cushing ‘25

Major: Neuroscience

Mentors: Professor Melissa VanderKaay Tomasulo (Psychology) and Professor Dagan Loisel (Biology)

For the past year, Fane-Cushing worked on a questionnaire research study, asking student-athletes a variety of questions related to their own perceptions of their stress and anxiety levels. Findings from this questionnaire will be used for a longitudinal study that tests the impact of virtual reality meditation on student-athletes’ stress levels. Over the summer, Fane-Cushing will be working on an institutional review board proposal, so that by the time the fall semester begins, his future research project can launch. “In past research projects with Professor Tomasulo and Loisel, VR meditation has been shown to be successful in reducing self-perceived stress,” Fane-Cushing said. With this project, Fane-Cushing aims to replicate these results, this time with student-athlete participants. Both self-perception and biological measures, such as heart rate and blood pressure, will be used in this study. As a student-athlete himself, Fane-Cushing said, “It is important that our student-athletes can perform at their best and our study will hopefully show that training the mind is as important as training the body.”

“New, Naturally-Derived Food Preservatives”

Ken Zou ‘26

Major: Chemistry

Mentor: Professor Mark Scialdone (Chemistry)

Zou is working with THC and CBD strands and hopes that by the end of the project, they can be used as natural preservatives. Zou is using strawberries and bagels to test this possibility, observing how long mold takes to form on these foods. “Ken did six compounds in just two weeks, which already exceeded our expectations,” Scialdone said.

“Developing and Running an Immunoprecipitation Assay for the Binding Partners of X-MAID Moesin in T cells”

Gavin Graham ‘25

Major: Biochemistry

Mentor: Professor Lyndsay Avery (Biology)

X-Linked Moesin Associated Immunodeficiency (X-MAID) is a genetic disease associated with lymphopenia, neutropenia, and bacterial infections, affecting T cells and T cell migration. Graham will develop an immunoprecipitation assay to better understand one of the specific mutations of moesin, and how it can affect T cell function. He hopes that a better understanding the mutation will help in effectively treating the X-MAID disease and mitigate patients’ symptoms.

“Analyzing the Effect of X-MAID Mutant Moesin Expression in T cell During Mitosis”

Olivia Goldfarb ‘27

Major: Biology

Goldfarb will study how the X-MAID mutation of T cells affects the final stage of mitosis (cell division), or telophase, as compared to a control group of healthy moesin. A healthy moesin protein allows for the effective division of T cells. Understanding these underlying mechanisms can help provide better insights into the role of moesin in T cell biology. X-MAID is a serious immunodeficiency illness, and with this research, Goldfarb hopes her findings will aid the treatment of X-MAID, having a direct impact on patients, and improving their quality of life.

“Perception and Purpose: A Catalog of the Modern History of Israelis and Palestinians”

Isabella Cronin ’25

Major: International Relations

Mentor: Professor M.J. Bosia (Political Science, International Relations, Gender & Sexuality Studies)

After studying abroad in Jordan, Cronin paid close attention to regional media as violence between Israel and Gaza escalated last fall. She compared those narratives to Western media and found different narratives. With this research, Cronin aims to pull together Israeli and Palestinian views on major historical events, such as the Nakba. Cronin aims to create an online catalog defining terms such as “genocide,” “settler colonialism,” “Zionism,” “diaspora,” “Palestinian liberation,” “right to defense,” and more. Cronin will be working on an interactive catalog with descriptions, definitions, historical context, a timeline of events, and key figures.

“Transcribing Early American Documents Relating to the Founding of the Virginia State Penitentiary”

Julianne Giordano ‘27

Majors: History and Secondary Education

Mentor: Professor Alexi Garrett (History)

Giordano is transcribing Virginia State Penitentiary documents, such as letters and criminal records dating back to the first two decades of the 1800s, which are related to Professor Garrett’s research. In this research, she will be paying special attention to indications of racial and gender bias within the prison. Giordano will be translating information about convicted criminals into charts, and produce a cumulative paper. Findings will provide research for a chapter of Professor Garrett’s book, and to co-write a journal article.

“How do College Campuses Respond to Students’ Mental Health Crises?”

Damien Wortheim ‘26

Majors: Psychology and Equity Studies

Mentor: Professor Sarah Nosek (Psychology)

For this research, Wortheim will explore how college campuses support student mental health through their apporach to crisis intervention. By performing content analyses on colleges’ response protocols from several departments, Wortheim’s research will support Clinical-Counseling Psychology graduate student Kaitlyn Root’s master thesis on crisis intervention on college campuses. Wortheim will be in charge of early stage research, such as content analysis and archival research, looking at how different universities’ approach mental health crises.

“The Other Side of the Story: Healthcare Providers’ Perspectives on Chronic Pain”

Lauren Welch ‘25

Major: Psychology

Mentor: Professor Sarah Nosek (Psychology)

Through interviews with healthcare providers, Welch will explore their perspectives on interacting with and treating chronic pain patients. Topics of exploration include perceptions of chronic pain, ways of communicating with patients, and challenges of managing and treating chronic pain. Welch expects her findings will show that the relationship between chronic pain patients and their healthcare providers is impacted by both interpersonal factors and systemic challenges. With this research, Welch hopes to uncover important issues that if addressed, could greatly improve well-being both for patients and providers.

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Saint Michael's students kick off on-campus research projects for
On Tuesday, June 4, students and professors gathered in the Roy Room to offer some insight into their summer research projects. From student-athlete mental health and historical beliefs about crime to immunoprecipitation and environmental paleolimnology, students are performing important research on a variety of topics and questions facing the world today.

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